# PROGRESSIVE HEALTH CARE PROVIDERS/FERN PARK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fern Park Developmental Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447259254
- **Authorized official:** MR. TERRY REVELL (ADMINISTRATOR)
- **Authorized official phone:** (407) 331-7231

## Contact information

- **Practice address:** 230 FERN PARK BLVD, FERN PARK, FL 32730-2500
- **Practice address phone:** (407) 331-7231
- **Practice address fax:** (407) 331-9251
- **Mailing address:** 230 FERN PARK BLVD, FERN PARK, FL 32730-2500
- **Mailing address phone:** (407) 331-7231
- **Mailing address fax:** (407) 331-9251

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 4022095 | FL | Yes |

## Other

- **Enumeration date:** 07/14/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4022095 | ICF/DD LICENSE | FL |