Provider Demographics
NPI:1457641524
Name:PROGRESSIVE RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:PROGRESSIVE RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BALLIRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMBALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-885-1994
Mailing Address - Street 1:11943 YOAKUM DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-2337
Mailing Address - Country:US
Mailing Address - Phone:214-494-4508
Mailing Address - Fax:214-494-4508
Practice Address - Street 1:11943 YOAKUM DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-2337
Practice Address - Country:US
Practice Address - Phone:214-494-4508
Practice Address - Fax:214-494-4508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities