Organization
PROGRESSIVE LIVING WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYDDIA GETAWERU (EXECUTIVE DIRECTOR)
(480) 773-8480
Entity
Organization
Contact information
Practice address
2177 E WARNER RD STE 101, TEMPE, AZ 85284-3511
(480) 773-8480
(480) 546-3626
Mailing address
2177 E WARNER RD STE 101, TEMPE, AZ 85284-3511
(480) 773-8480
(480) 546-3626
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BH7784
—
AZ
Enumeration date
07/12/2022
Last updated
07/12/2022
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