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General NPI Number Information
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NPI Number | 1154473155
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE ADULT REHABILITATION CENTER, INC.
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/03/2017
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Provider Practice Location Address
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Address Line | 114 NORTH UNION STREET SUITE B
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City | PETERSBURG
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State | VA
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Zip | 23803
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Country | US
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Telephone | 804-732-0685
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Fax | 804-732-4988
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Provider Business Mailing Address
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Address Line | PO BOX 2085 114 NORTH UNION STREET SUITE B
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City | PETERSBURG
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State | VA
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Zip | 23803
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Country | US
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Telephone | 804-732-0685
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Fax | 804-732-4988
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. FELICIA B DANIELS
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Credential | MSW
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Telephone | 804-732-0685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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