Provider Demographics
NPI:1790956688
Name:PROGRESSIVE HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:PROGRESSIVE HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-244-0511
Mailing Address - Street 1:6022 JEFFERSON AVE
Mailing Address - Street 2:STE 204C
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-3000
Mailing Address - Country:US
Mailing Address - Phone:757-244-0511
Mailing Address - Fax:757-320-2900
Practice Address - Street 1:6022 JEFFERSON AVE
Practice Address - Street 2:STE 204C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-3000
Practice Address - Country:US
Practice Address - Phone:757-244-0511
Practice Address - Fax:757-320-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001192912251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health