Healthcare Provider Details

I. General information

NPI: 1982891917
Provider Name (Legal Business Name): CGM PROGRESSIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 E JUAREZ ST
PHARR TX
78577-4316
US

IV. Provider business mailing address

1305 E JUAREZ ST
PHARR TX
78577-4316
US

V. Phone/Fax

Practice location:
  • Phone: 956-702-3870
  • Fax: 956-702-3875
Mailing address:
  • Phone: 956-702-3870
  • Fax: 956-702-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number120132
License Number StateTX

VIII. Authorized Official

Name: MS. DENISE Y GUERRA
Title or Position: MANAGING MEMBER/ADMINISTRATOR
Credential:
Phone: 956-702-3870