MEDICARE: PROGRESSIVE LIFE FAMILY SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1427492867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE LIFE FAMILY SERVICES

Provider Business Mailing Address
First Line	:	5611 HALVERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-1730
Country	:	US
Telephone Number	:	702-372-9327
Fax Number	:

Provider Business Practice Location Address
First Line	:	5611 HALVERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-1730
Country	:	US
Telephone Number	:	702-372-9327
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GLORIA WOOTEN
Credential	:
Telephone Number	:	702-373-1651

Provider Enumeration Date	:	04/27/2013
Last Update Date	:	04/27/2013

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Directions to “PROGRESSIVE LIFE FAMILY SERVICES ” Practice Location

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