Provider Demographics
NPI:1164726634
Name:NEW PROGRESSIONS, LLC
Entity Type:Organization
Organization Name:NEW PROGRESSIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOVON
Authorized Official - Middle Name:KENANE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-254-6770
Mailing Address - Street 1:620 GUILFORD COLLEGE RD
Mailing Address - Street 2:G
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-2292
Mailing Address - Country:US
Mailing Address - Phone:336-254-6770
Mailing Address - Fax:336-292-1589
Practice Address - Street 1:620 GUILFORD COLLEGE RD
Practice Address - Street 2:G
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-2292
Practice Address - Country:US
Practice Address - Phone:336-254-6770
Practice Address - Fax:336-292-1589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3410135Medicaid