MEDICARE: PROGRESSIVE CHOICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	N31-00006	NV
2	251C00000X	Developmentally Disabled Services Day Training Agency	NV19971181709	NV
3	385H00000X	Respite Care	385H00000X	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9005038318	OTHER	NV	API

General Provider Information

NPI Number	:	1376902387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE CHOICES, INC.

Provider Business Mailing Address
First Line	:	3000 RIGEL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0709
Country	:	US
Telephone Number	:	702-218-7839
Fax Number	:	702-248-9447

Provider Business Practice Location Address
First Line	:	3014 RIGEL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0709
Country	:	US
Telephone Number	:	702-248-9484
Fax Number	:	702-248-9447

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. RANDI E SANDIDGE
Credential	:
Telephone Number	:	702-248-9484

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	02/23/2016

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Directions to “PROGRESSIVE CHOICES, INC. ” Practice Location

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