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General NPI Number Information
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NPI Number | 1619137999
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE ALTERNATIVES, INC.
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 10476 W U AVE
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City | SCHOOLCRAFT
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State | MI
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Zip | 49087-8475
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Country | US
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Telephone | 269-679-2273
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Fax | 269-679-2738
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Provider Business Mailing Address
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Address Line | PO BOX 20054
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City | KALAMAZOO
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State | MI
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Zip | 49019-1054
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Country | US
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Telephone | 269-679-2738
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Fax | 269-679-2738
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY A NOLAN
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Credential | RN, CEO
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Telephone | 269-679-2738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AS390016162
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License Number State | MI
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