Provider Demographics
NPI:1518375930
Name:PROGRESSIVE HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEGATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON-ARDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-205-1824
Mailing Address - Street 1:3636 S SHERWOOD FOREST BLVD STE 690
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5206
Mailing Address - Country:US
Mailing Address - Phone:225-205-1824
Mailing Address - Fax:
Practice Address - Street 1:3636 S SHERWOOD FOREST BLVD STE 690
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5206
Practice Address - Country:US
Practice Address - Phone:225-205-1824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health