MEDICARE: PROGRESSIVE COMMUNITY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	1447-9743	MO

General Provider Information

NPI Number	:	1629194899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	1025 N 22ND ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2607
Country	:	US
Telephone Number	:	816-364-3827
Fax Number	:	816-364-0470

Provider Business Practice Location Address
First Line	:	1025 N 22ND ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2607
Country	:	US
Telephone Number	:	816-364-3827
Fax Number	:	816-364-0470

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. LYNN WELLS
Credential	:
Telephone Number	:	816-364-3827

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/22/2020

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Directions to “PROGRESSIVE COMMUNITY SERVICES ” Practice Location

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