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05D2107170 CLIA NUMBER - PROGRESSIVE HOME HEALTH & HOSPICE CARE, LLC DBA PROGRESSIVE HOME HEALTH

Laboratory Demographics

CLIA Number: 05D2107170

Facility Name: PROGRESSIVE HOME HEALTH & HOSPICE CARE, LLC DBA PROGRESSIVE HOME HEALTH

Facility Address:
1619 H STREET
MODESTO, CA
ZIP 95354
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Facility Phone Number: 209 248-7700

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1558800243

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 05D2107170
LAB Type Home Health Agency
Facility Name PROGRESSIVE HOME HEALTH & HOSPICE CARE, LLC DBA PROGRESSIVE HOME HEALTH
Street 1619 H STREET
City MODESTO
State CA
ZIP 95354
Phone 209 248-7700
CertificateType 4
CertificateEffectiveDate 1/7/2024
CertificateExpirationDate 1/6/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024