Provider Demographics
NPI:1477198760
Name:PROGRESSIVE SERVICES OF VIRGINIA LLC
Entity Type:Organization
Organization Name:PROGRESSIVE SERVICES OF VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MHA
Authorized Official - Phone:757-343-9573
Mailing Address - Street 1:5040 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6637
Mailing Address - Country:US
Mailing Address - Phone:757-343-9573
Mailing Address - Fax:757-257-0544
Practice Address - Street 1:5040 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6637
Practice Address - Country:US
Practice Address - Phone:757-343-9573
Practice Address - Fax:757-257-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care