Provider Demographics
NPI:1144419078
Name:PROGRESSIVE HOME WOUND CARE, INC
Entity type:Organization
Organization Name:PROGRESSIVE HOME WOUND CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:309-737-5286
Mailing Address - Street 1:1634 AVENUE OF THE CITIES STE D
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4860
Mailing Address - Country:US
Mailing Address - Phone:309-737-5826
Mailing Address - Fax:
Practice Address - Street 1:1634 AVENUE OF THE CITIES STE D
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4860
Practice Address - Country:US
Practice Address - Phone:309-762-9711
Practice Address - Fax:309-764-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL246859OtherCORPORATION NUMBER
IL357440451001Medicaid
IL357440451001Medicaid