Provider Demographics
NPI:1851635312
Name:PROGRESSIVE COMMUNITY CARE CENTER, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE COMMUNITY CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KEYORKA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-615-5549
Mailing Address - Street 1:3205 HWY 51
Mailing Address - Street 2:STE C
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068
Mailing Address - Country:US
Mailing Address - Phone:985-224-2151
Mailing Address - Fax:985-224-2156
Practice Address - Street 1:3205 HWY 51
Practice Address - Street 2:STE C
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068
Practice Address - Country:US
Practice Address - Phone:985-224-2151
Practice Address - Fax:985-224-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health