Healthcare Provider Details

I. General information

NPI: 1801942529
Provider Name (Legal Business Name): PROGRESSIVE RESIDENTIAL SERVICES OF NEW MEXICO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S MAIN ST SUITE A
LAS CRUCES NM
88001-1278
US

IV. Provider business mailing address

6001 N ADAMS RD SUITE 165
BLOOMFIELD HILLS MI
48304-1566
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-8431
  • Fax:
Mailing address:
  • Phone: 248-641-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RACHEL GUILFORD
Title or Position: COO
Credential:
Phone: 248-641-7200