Provider Demographics
NPI:1649575259
Name:PROGRESSIVE CENTER FOR INDEPENDENT LIVING, INC
Entity Type:Organization
Organization Name:PROGRESSIVE CENTER FOR INDEPENDENT LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-581-4500
Mailing Address - Street 1:1262 WHITEHORSE HAMILTON SQ RD
Mailing Address - Street 2:BLDG A, SUITE 102
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3710
Mailing Address - Country:US
Mailing Address - Phone:609-581-4500
Mailing Address - Fax:609-581-4555
Practice Address - Street 1:1262 WHITEHORSE HAMILTON SQUARE RD
Practice Address - Street 2:BLDG A, SUITE 102
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3711
Practice Address - Country:US
Practice Address - Phone:609-581-4500
Practice Address - Fax:609-581-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management