Provider Demographics
NPI:1851842512
Name:PROGRESSIVE LIFESTYLE INC
Entity Type:Organization
Organization Name:PROGRESSIVE LIFESTYLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-666-4136
Mailing Address - Street 1:6600 HIGHLAND RD
Mailing Address - Street 2:STE 11A
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1673
Mailing Address - Country:US
Mailing Address - Phone:248-666-4136
Mailing Address - Fax:
Practice Address - Street 1:556 LOCHAVEN RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-3840
Practice Address - Country:US
Practice Address - Phone:248-682-6396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health