Basic Information
| Provider Information | |||||||||
| NPI: | 1518375930 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE HEALTHCARE SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3636 S SHERWOOD FOREST BLVD STE 690 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708165206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252051824 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3636 S SHERWOOD FOREST BLVD STE 690 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708165206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252051824 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2014 | ||||||||
| LastUpdateDate: | 07/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | WILSON-ARDOIN | ||||||||
| AuthorizedOfficialFirstName: | NEGATHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2252051824 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 251C00000X | Y | Agencies | Day Training, Developmentally Disabled Services |
No ID Information.