Provider Demographics
NPI:1073728119
Name:PROGRESSIVE HEALTHCARE PROVIDERS INC
Entity Type:Organization
Organization Name:PROGRESSIVE HEALTHCARE PROVIDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-767-2344
Mailing Address - Street 1:8280 YMCA PLAZA DR BLDG 9
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0927
Mailing Address - Country:US
Mailing Address - Phone:225-767-2344
Mailing Address - Fax:225-767-8068
Practice Address - Street 1:8280 YMCA PLAZA DR BLDG 9
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0927
Practice Address - Country:US
Practice Address - Phone:225-767-2344
Practice Address - Fax:225-767-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA850251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1714151Medicaid