Provider Demographics
NPI:1821618596
Name:PROGRESSIVE COMMUNITY RESOURCES
Entity Type:Organization
Organization Name:PROGRESSIVE COMMUNITY RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LINKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:610-873-4813
Mailing Address - Street 1:107 W PLOVER WAY
Mailing Address - Street 2:
Mailing Address - City:LAVALLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:08735-1237
Mailing Address - Country:US
Mailing Address - Phone:610-873-4813
Mailing Address - Fax:610-873-4813
Practice Address - Street 1:107 W PLOVER WAY
Practice Address - Street 2:
Practice Address - City:LAVALLETTE
Practice Address - State:NJ
Practice Address - Zip Code:08735-1237
Practice Address - Country:US
Practice Address - Phone:610-873-4813
Practice Address - Fax:610-873-4813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities