Provider Demographics
NPI:1760146948
Name:PROGRESSIVE LIVING 2, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE LIVING 2, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GETAWERU
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:480-773-8480
Mailing Address - Street 1:46011 W MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-6795
Mailing Address - Country:US
Mailing Address - Phone:480-773-8480
Mailing Address - Fax:480-546-3626
Practice Address - Street 1:46011 W MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-6795
Practice Address - Country:US
Practice Address - Phone:480-773-8480
Practice Address - Fax:480-546-3626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH BEHAVIORAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility