Organization
PROGRESSIVE LIFE, LTD
Active
Other names
Progressive Life of Central Texas
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY BOWERS (PRESIDENT)
(210) 340-7155
Entity
Organization
Contact information
Practice address
17016 COPPERHEAD DR, ROUND ROCK, TX 78664-8616
(512) 892-2191
Mailing address
2579 WESTERN TRAILS BLVD, AUSTIN, TX 78745-1578
(512) 892-2191
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001008861
—
TX
Enumeration date
09/10/2010
Last updated
09/10/2010
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