Provider Demographics
NPI:1740019207
Name:PROGRESSIVE LIVING SOLUTIONS, INC.
Entity type:Organization
Organization Name:PROGRESSIVE LIVING SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:STREATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-303-6769
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-0566
Mailing Address - Country:US
Mailing Address - Phone:651-303-6769
Mailing Address - Fax:651-674-6280
Practice Address - Street 1:6243 384TH LN
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-3318
Practice Address - Country:US
Practice Address - Phone:651-303-6769
Practice Address - Fax:651-674-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health