Provider Demographics
NPI:1619391893
Name:PROGRESSIVE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PROGRESSIVE HEALTH SERVICES LLC
Other - Org Name:PROGRESSIVE BEHAVIORAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOHIREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-402-8175
Mailing Address - Street 1:2440 SANDY PLAINS RD
Mailing Address - Street 2:BLG 21, SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7217
Mailing Address - Country:US
Mailing Address - Phone:404-402-8175
Mailing Address - Fax:678-581-1836
Practice Address - Street 1:2440 SANDY PLAINS RD
Practice Address - Street 2:BLG 21, SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7217
Practice Address - Country:US
Practice Address - Phone:404-402-8175
Practice Address - Fax:678-581-1836
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMFORT COMMUNITY CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-10
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization