Provider Demographics
NPI:1861907339
Name:THE CENTER FOR PROGRESS AND EXCELLENCE, INC
Entity type:Organization
Organization Name:THE CENTER FOR PROGRESS AND EXCELLENCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAN-PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOJICA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-689-8490
Mailing Address - Street 1:11940 FAIRWAY LAKES DR STE 4
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8385
Mailing Address - Country:US
Mailing Address - Phone:239-689-8490
Mailing Address - Fax:239-689-8103
Practice Address - Street 1:11940 FAIRWAY LAKES DR STE 4
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8385
Practice Address - Country:US
Practice Address - Phone:239-689-8490
Practice Address - Fax:239-689-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010785500Medicaid