Provider Demographics
NPI:1154575025
Name:PROGRESSIVE FAMILIES
Entity type:Organization
Organization Name:PROGRESSIVE FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATARRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MED MED
Authorized Official - Phone:615-584-3098
Mailing Address - Street 1:528 THOMAS JEFFERSON CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2162
Mailing Address - Country:US
Mailing Address - Phone:615-579-5310
Mailing Address - Fax:615-868-4048
Practice Address - Street 1:528 THOMAS JEFFERSON CIR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2162
Practice Address - Country:US
Practice Address - Phone:615-579-5310
Practice Address - Fax:615-868-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN123009251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management