Organization
PROGRESSIVE BEHAVIOR SYSTEMS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERROD K CATMULL (OWNER)
(208) 312-1911
Entity
Organization
Contact information
Practice address
512 6TH ST, RUPERT, ID 83350-1621
(208) 436-4911
(208) 436-1758
Mailing address
PO BOX 714, RUPERT, ID 83350-0714
(208) 436-4911
(208) 436-1758
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
5PBSYSTEM087
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806228000
—
ID
05
—
806377200
—
ID
05
—
807307600
—
ID
05
—
807353100
—
ID
Enumeration date
03/06/2007
Last updated
10/03/2007
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