Provider Demographics
NPI:1801942529
Name:PROGRESSIVE RESIDENTIAL SERVICES OF NEW MEXICO, INC.
Entity type:Organization
Organization Name:PROGRESSIVE RESIDENTIAL SERVICES OF NEW MEXICO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-641-7200
Mailing Address - Street 1:6001 N ADAMS RD
Mailing Address - Street 2:SUITE 165
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1566
Mailing Address - Country:US
Mailing Address - Phone:248-641-7200
Mailing Address - Fax:
Practice Address - Street 1:250 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1278
Practice Address - Country:US
Practice Address - Phone:575-523-8431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD4244Medicaid