Provider Demographics
NPI:1659351534
Name:PROGRESSIVE PREVENTIVE HEALTH CARE, INC
Entity Type:Organization
Organization Name:PROGRESSIVE PREVENTIVE HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LCSW,LPC
Authorized Official - Phone:304-842-8852
Mailing Address - Street 1:243 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1748
Mailing Address - Country:US
Mailing Address - Phone:304-842-8852
Mailing Address - Fax:304-842-8853
Practice Address - Street 1:243 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1748
Practice Address - Country:US
Practice Address - Phone:304-842-8852
Practice Address - Fax:304-842-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP 00453683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5564563OtherAETNA
WVY 485146OtherHEALTH PLAN
WVY 485146OtherHEALTH PLAN