Provider Demographics
NPI:1689916827
Name:PROGRESSIONS TLC LLC
Entity Type:Organization
Organization Name:PROGRESSIONS TLC LLC
Other - Org Name:PROGRESSIONS TLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:RS, RW
Authorized Official - Phone:818-324-2507
Mailing Address - Street 1:PO BOX 6032
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-6032
Mailing Address - Country:US
Mailing Address - Phone:818-324-2507
Mailing Address - Fax:888-310-4278
Practice Address - Street 1:5510 WILBUR AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3219
Practice Address - Country:US
Practice Address - Phone:818-324-2507
Practice Address - Fax:888-310-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190768AP101YA0400X, 261QR0405X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190768APOtherCALIFORNIA DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS LICENSE AND CERTIFICATION