Healthcare Provider Details

I. General information

NPI: 1043422660
Provider Name (Legal Business Name): PROGRESSIVE LIFESTYLES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 N OAKLAND BLVD STE 150
WATERFORD MI
48327-4526
US

IV. Provider business mailing address

1370 N OAKLAND BLVD STE 150
WATERFORD MI
48327-4526
US

V. Phone/Fax

Practice location:
  • Phone: 248-607-6507
  • Fax: 248-607-6507
Mailing address:
  • Phone: 248-607-6507
  • Fax: 248-336-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER J WILLIAMS
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 248-607-6507