Provider Demographics
NPI:1376300749
Name:PROGRESSIVE HEALTH OF HOUSTON, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE HEALTH OF HOUSTON, LLC
Other - Org Name:PROGRESSIVE HEALTH OF HOUSTON--GERO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:QUENTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITWELL
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:662-701-9346
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-0626
Mailing Address - Country:US
Mailing Address - Phone:662-456-3700
Mailing Address - Fax:662-456-1717
Practice Address - Street 1:1002 E MADISON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-2428
Practice Address - Country:US
Practice Address - Phone:662-456-3700
Practice Address - Fax:662-456-1717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE HEALTH OF HOUSTON, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-04
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit