Provider Demographics
NPI:1982891917
Name:CGM PROGRESSIVE SERVICES LLC
Entity Type:Organization
Organization Name:CGM PROGRESSIVE SERVICES LLC
Other - Org Name:SU CASA ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-702-3870
Mailing Address - Street 1:1305 E JUAREZ ST
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-4316
Mailing Address - Country:US
Mailing Address - Phone:956-702-3870
Mailing Address - Fax:956-702-3875
Practice Address - Street 1:1305 E JUAREZ ST
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-4316
Practice Address - Country:US
Practice Address - Phone:956-702-3870
Practice Address - Fax:956-702-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120132261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX-108-6084OtherSPECIAL NUTRITION PROGRAM