Provider Demographics
NPI:1821393448
Name:PROFESSIONAL GROUP LIVING, LLC
Entity type:Organization
Organization Name:PROFESSIONAL GROUP LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALKA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOCK MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-806-6726
Mailing Address - Street 1:510 SIMMONS ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4334
Mailing Address - Country:US
Mailing Address - Phone:919-806-6726
Mailing Address - Fax:
Practice Address - Street 1:510 SIMMONS ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-4334
Practice Address - Country:US
Practice Address - Phone:919-806-6726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management