Provider Demographics
NPI:1306471420
Name:PROGRESS RANCH TREATMENT SERVICES FOR CHILDREN
Entity type:Organization
Organization Name:PROGRESS RANCH TREATMENT SERVICES FOR CHILDREN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WHISTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-753-2566
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-1287
Mailing Address - Country:US
Mailing Address - Phone:530-753-2566
Mailing Address - Fax:
Practice Address - Street 1:3840 ROSIN CT STE 240
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1639
Practice Address - Country:US
Practice Address - Phone:530-746-1544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty