Provider Demographics
NPI:1508020892
Name:PROFESSIONAL GROUP LIVING, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL GROUP LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALKA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCK MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-475-5845
Mailing Address - Street 1:4084 BARRETT DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6604
Mailing Address - Country:US
Mailing Address - Phone:919-785-9660
Mailing Address - Fax:
Practice Address - Street 1:4084 BARRETT DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6604
Practice Address - Country:US
Practice Address - Phone:919-785-9660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health