Provider Demographics
NPI:1073064713
Name:PROGRESSIVE LIFESTYLE INC
Entity Type:Organization
Organization Name:PROGRESSIVE LIFESTYLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JOANNE
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:
Practice Address - Street 1:3410 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3014
Practice Address - Country:US
Practice Address - Phone:248-673-2845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health