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General NPI Number Information
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NPI Number | 1760146948
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE LIVING 2, LLC
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 46011 W MOUNTAIN VIEW RD
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City | MARICOPA
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State | AZ
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Zip | 85139-6795
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Country | US
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Telephone | 480-773-8480
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Fax | 480-546-3626
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Provider Business Mailing Address
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Address Line | 46011 W MOUNTAIN VIEW RD
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City | MARICOPA
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State | AZ
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Zip | 85139-6795
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Country | US
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Telephone | 480-773-8480
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Fax | 480-546-3626
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Authorized Official
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Title or Position | CEO/OWNER
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Name | LYDDIA GETAWERU
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Credential | MBA
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Telephone | 480-773-8480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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