Healthcare Provider Details

I. General information

NPI: 1851733224
Provider Name (Legal Business Name): PROGRESSIVE LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CREATIVE CT
MANKATO MN
56001-5794
US

IV. Provider business mailing address

105 CREATIVE CT
MANKATO MN
56001-5794
US

V. Phone/Fax

Practice location:
  • Phone: 507-381-4211
  • Fax:
Mailing address:
  • Phone: 507-381-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: ROBERT CHARLES SWEENEY
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 507-381-4211