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General NPI Number Information
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NPI Number | 1760620520
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE CARE SERVICES INC
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Dates
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Enumeration Date | 01/31/2009
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Last Update Date | 01/31/2009
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Provider Practice Location Address
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Address Line | 3216 ZEBULON RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2435
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Country | US
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Telephone | 252-452-3302
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Fax |
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Provider Business Mailing Address
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Address Line | 3216 ZEBULON RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2435
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Country | US
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Telephone | 252-452-3302
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. VICTOR RANDOLPH MOORE JR.
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Credential |
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Telephone | 252-452-3302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | NC
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