Provider Demographics
NPI:1043422660
Name:PROGRESSIVE LIFESTYLES, INC.
Entity Type:Organization
Organization Name:PROGRESSIVE LIFESTYLES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-607-6507
Mailing Address - Street 1:1370 N OAKLAND BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-4526
Mailing Address - Country:US
Mailing Address - Phone:248-607-6507
Mailing Address - Fax:248-336-9120
Practice Address - Street 1:1370 N OAKLAND BLVD STE 150
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-4526
Practice Address - Country:US
Practice Address - Phone:248-607-6507
Practice Address - Fax:248-607-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization