Provider Demographics
NPI:1225798382
Name:PROGRESSIVE HEALTH ALLIANCE LLC
Entity Type:Organization
Organization Name:PROGRESSIVE HEALTH ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKHARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-427-6723
Mailing Address - Street 1:4605 W DONNER DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-4266
Mailing Address - Country:US
Mailing Address - Phone:480-427-6723
Mailing Address - Fax:
Practice Address - Street 1:4605 W DONNER DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-4266
Practice Address - Country:US
Practice Address - Phone:480-427-6723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health