1518094937 NPI number — PROGRESS VALLEY, INC.

Table of content: (NPI 1518094937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518094937 NPI number — PROGRESS VALLEY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESS VALLEY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518094937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 E 80TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55420-1426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-956-3100
Provider Business Mailing Address Fax Number:
612-869-3225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3033 GARFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55408-2924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-827-2517
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOSTROM
Authorized Official First Name:
JARED
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
952-956-3101

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  801979-1-CDT , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 855856600 . This is a "MHCP PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".