Provider Demographics
NPI:1669944724
Name:PROGRESSIVE INSTITUTE LLC
Entity type:Organization
Organization Name:PROGRESSIVE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-816-6424
Mailing Address - Street 1:2 TRAP FALLS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4616
Mailing Address - Country:US
Mailing Address - Phone:203-816-6424
Mailing Address - Fax:203-513-8474
Practice Address - Street 1:2 TRAP FALLS RD STE 120
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4616
Practice Address - Country:US
Practice Address - Phone:203-816-6424
Practice Address - Fax:630-522-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder