Organization
PROGRESSIVE HABILITATIVE SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAMESH GUNDU (ACCOUNTS MANAGER)
(301) 317-9996
Entity
Organization
Contact information
Practice address
6405 CHILLUM PL NW, WASHINGTON, DC 20012-2133
(202) 545-0393
(202) 545-0392
Mailing address
13629 BALTIMORE AVE, LAUREL, MD 20707-5095
(301) 317-9996
(301) 317-9988
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037910700
—
DC
Enumeration date
07/23/2010
Last updated
09/23/2015
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