Provider Demographics
NPI:1346619541
Name:PROGRESSIVE THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:PROGRESSIVE THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SYRETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-600-1056
Mailing Address - Street 1:1133 175TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-4604
Mailing Address - Country:US
Mailing Address - Phone:708-339-0110
Mailing Address - Fax:708-455-8546
Practice Address - Street 1:1133 175TH ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-4604
Practice Address - Country:US
Practice Address - Phone:708-339-0110
Practice Address - Fax:708-455-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services