Provider Demographics
NPI:1851072169
Name:PROGRESSIVE RECOVERY RESOURCES HOMES LLC
Entity Type:Organization
Organization Name:PROGRESSIVE RECOVERY RESOURCES HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-891-6404
Mailing Address - Street 1:3129 CREIGHTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6209
Mailing Address - Country:US
Mailing Address - Phone:704-891-6404
Mailing Address - Fax:980-225-0560
Practice Address - Street 1:3129 CREIGHTON DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6209
Practice Address - Country:US
Practice Address - Phone:704-891-6404
Practice Address - Fax:980-225-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities