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Organization
PROGRESSIVE ADULT REHABILITATION CENTER, INC.
Active
Organization
PROGRESSIVE ADULT REHABILITATION CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FELICIA B DANIELS MSW (EXECUTIVE DIRECTOR)
(804) 732-0685
Entity
Organization
Contact information
Practice address
114 NORTH UNION STREET, SUITE B, PETERSBURG, VA 23803
(804) 732-0685
(804) 732-4988
Mailing address
PO BOX 2085, 114 NORTH UNION STREET SUITE B, PETERSBURG, VA 23803
(804) 732-0685
(804) 732-4988
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4943899
MEDICAID
VA
05
—
4946634
—
VA
Enumeration date
01/18/2007
Last updated
08/03/2017
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