Healthcare Provider Details

I. General information

NPI: 1518375930
Provider Name (Legal Business Name): PROGRESSIVE HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 S SHERWOOD FOREST BLVD STE 690
BATON ROUGE LA
70816-5206
US

IV. Provider business mailing address

3636 S SHERWOOD FOREST BLVD STE 690
BATON ROUGE LA
70816-5206
US

V. Phone/Fax

Practice location:
  • Phone: 225-205-1824
  • Fax:
Mailing address:
  • Phone: 225-205-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. NEGATHA WILSON-ARDOIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 225-205-1824