Organization
PROGRESS HOUSE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM AVEY (EXECUTIVE DIRECTOR)
(530) 626-9240
Entity
Organization
Contact information
Practice address
5494 PONY EXPRESS TRAIL, HOUSE 4, CAMINO, CA 95709
(530) 644-3758
Mailing address
PO BOX 1666, SUITE B, PLACERVILLE, CA 95667-1666
(530) 626-9240
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
090002FN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090918
DRUG MEDI-CAL
CA
Enumeration date
02/19/2008
Last updated
02/19/2008
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