Provider Demographics
NPI:1457382186
Name:PROGRESSIVE BEHAVIORAL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE BEHAVIORAL HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:732-557-4422
Mailing Address - Street 1:520 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7444
Mailing Address - Country:US
Mailing Address - Phone:732-557-4422
Mailing Address - Fax:732-557-4422
Practice Address - Street 1:520 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7444
Practice Address - Country:US
Practice Address - Phone:732-557-4422
Practice Address - Fax:732-557-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043122001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3156670OtherOXFORD
NJ327640OtherHEALTHNET
NJP3156670OtherOXFORD
NJ904267Medicare PIN