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General NPI Number Information
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NPI Number | 1548629231
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE LIFESTYLES HOME HEALTHCARE, LLC
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 40 RG STARLEY RD
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City | MC INTYRE
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State | GA
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Zip | 31054-2259
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Country | US
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Telephone | 478-946-0036
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 163
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City | IRWINTON
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State | GA
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Zip | 31042-0163
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Country | US
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Telephone | 478-946-0036
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | SAMANTHA WALKER
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Credential |
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Telephone | 478-233-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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