Provider Demographics
NPI:1215667761
Name:PROGRESS AZ LLC
Entity type:Organization
Organization Name:PROGRESS AZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWITAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RUMICHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-930-8424
Mailing Address - Street 1:7846 W TUCKEY LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-3413
Mailing Address - Country:US
Mailing Address - Phone:602-930-8424
Mailing Address - Fax:
Practice Address - Street 1:7113 W SOPHIE LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-3475
Practice Address - Country:US
Practice Address - Phone:602-930-8424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances