Provider Demographics
NPI:1306167515
Name:PROGRESSIVE INTERCHANGE HEALTHCARE LLC
Entity type:Organization
Organization Name:PROGRESSIVE INTERCHANGE HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:440-684-9220
Mailing Address - Street 1:5553 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1604
Mailing Address - Country:US
Mailing Address - Phone:216-661-6800
Mailing Address - Fax:216-739-3789
Practice Address - Street 1:4120 INTERCHANGE CORPORATE CENTER RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5631
Practice Address - Country:US
Practice Address - Phone:216-896-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3083336Medicaid
OH3083336Medicaid