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General NPI Number Information
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NPI Number | 1710022843
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE RESIDENTIAL SERVICES OF TENNESSEE, INC.
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 107 MUSIC CITY CIR SUITE 101
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City | NASHVILLE
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State | TN
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Zip | 37214-1214
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Country | US
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Telephone | 615-232-8186
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Fax | 615-232-8187
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Provider Business Mailing Address
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Address Line | 6001 N ADAMS RD SUITE 165
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48304-1566
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Country | US
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Telephone | 248-641-7200
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Fax | 248-641-9338
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Authorized Official
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Title or Position | COO
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Name | RACHEL GUILFORD
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Credential |
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Telephone | 248-641-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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License Number |
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License Number State |
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