Healthcare Provider Details

I. General information

NPI: 1336265503
Provider Name (Legal Business Name): PROGRESSIVE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 N 22ND ST
SAINT JOSEPH MO
64506-2607
US

IV. Provider business mailing address

1025 N 22ND ST
SAINT JOSEPH MO
64506-2607
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-3827
  • Fax: 816-364-0470
Mailing address:
  • Phone: 816-364-3827
  • Fax: 816-364-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1447-9743
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1447-9743
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number1447-9743
License Number StateMO

VIII. Authorized Official

Name: MS. LYNN WELLS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 816-364-3827