Provider Demographics
NPI:1720162746
Name:PROGRESSIVE REHAB CENTER, INC.
Entity type:Organization
Organization Name:PROGRESSIVE REHAB CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCANLON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-755-3354
Mailing Address - Street 1:9494 CINCINNATI COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-1161
Mailing Address - Country:US
Mailing Address - Phone:513-755-8020
Mailing Address - Fax:513-755-8021
Practice Address - Street 1:9494 CINCINNATI COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-1161
Practice Address - Country:US
Practice Address - Phone:513-755-8020
Practice Address - Fax:513-755-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPR9332431Medicare PIN