Provider Demographics
NPI:1164735817
Name:PROGRESSIVE HABILITATIVE SERVICES, INC
Entity Type:Organization
Organization Name:PROGRESSIVE HABILITATIVE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-317-9996
Mailing Address - Street 1:13629 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5095
Mailing Address - Country:US
Mailing Address - Phone:301-317-9996
Mailing Address - Fax:301-317-9988
Practice Address - Street 1:6405 CHILLUM PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2133
Practice Address - Country:US
Practice Address - Phone:202-545-0393
Practice Address - Fax:202-545-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037910700Medicaid