Provider Demographics
NPI:1760636609
Name:CENTER OF PROGRESSIVE STRIDES INC
Entity Type:Organization
Organization Name:CENTER OF PROGRESSIVE STRIDES INC
Other - Org Name:PROGRESSIVE STEPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HINSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-303-6570
Mailing Address - Street 1:4103 LANDERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-8510
Mailing Address - Country:US
Mailing Address - Phone:336-303-6570
Mailing Address - Fax:
Practice Address - Street 1:29 HOLLY SPRINGS LN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-1526
Practice Address - Country:US
Practice Address - Phone:336-303-6570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-877322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children