Provider Demographics
NPI:1376902387
Name:PROGRESSIVE CHOICES, INC.
Entity Type:Organization
Organization Name:PROGRESSIVE CHOICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:E
Authorized Official - Last Name:SANDIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-248-9484
Mailing Address - Street 1:3000 RIGEL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0709
Mailing Address - Country:US
Mailing Address - Phone:702-218-7839
Mailing Address - Fax:702-248-9447
Practice Address - Street 1:3014 RIGEL AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0709
Practice Address - Country:US
Practice Address - Phone:702-248-9484
Practice Address - Fax:702-248-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVN31-00006251C00000X
NVNV19971181709251C00000X
NV385H00000X385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005038318OtherAPI