Provider Demographics
NPI:1497551592
Name:PROGRESSIVE LIFESTYLE RESOURCE AGENCY
Entity type:Organization
Organization Name:PROGRESSIVE LIFESTYLE RESOURCE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZATIONAL FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-996-6208
Mailing Address - Street 1:4000 BURCHARD WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8427 ROCK BOUND CT
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-5514
Practice Address - Country:US
Practice Address - Phone:415-996-6208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care