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General NPI Number Information
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NPI Number | 1376902387
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE CHOICES, INC.
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 3014 RIGEL AVE
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City | LAS VEGAS
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State | NV
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Zip | 89102-0709
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Country | US
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Telephone | 702-248-9484
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Fax | 702-248-9447
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Provider Business Mailing Address
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Address Line | 3000 RIGEL AVE
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City | LAS VEGAS
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State | NV
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Zip | 89102-0709
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Country | US
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Telephone | 702-218-7839
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Fax | 702-248-9447
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. RANDI E SANDIDGE
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Credential |
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Telephone | 702-248-9484
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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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License Number | N31-00006
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | NV19971181709
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 385H00000X
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License Number State | NV
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