MEDICARE: PROGRESSIVE OUTREACH SOLUTIONS LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1811693583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE OUTREACH SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	1776 HERITAGE CENTER DR STE 204
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-3977
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 HERITAGE CENTER DR STE 204
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-3977
Country	:	US
Telephone Number	:	919-264-2253
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RUSTOVIANT WRIGHTEN
Credential	:
Telephone Number	:	919-264-2253

Provider Enumeration Date	:	02/03/2023
Last Update Date	:	02/03/2023

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