Provider Demographics
NPI: | 1790956688 |
---|---|
Name: | PROGRESSIVE HEALTHCARE SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | PROGRESSIVE HEALTHCARE SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | GWEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FROST |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 757-244-0511 |
Mailing Address - Street 1: | 6022 JEFFERSON AVE |
Mailing Address - Street 2: | STE 204C |
Mailing Address - City: | NEWPORT NEWS |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23605-3000 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-244-0511 |
Mailing Address - Fax: | 757-320-2900 |
Practice Address - Street 1: | 6022 JEFFERSON AVE |
Practice Address - Street 2: | STE 204C |
Practice Address - City: | NEWPORT NEWS |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23605-3000 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-244-0511 |
Practice Address - Fax: | 757-320-2900 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-03-18 |
Last Update Date: | 2008-03-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0001192912 | 251E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |