Healthcare Provider Details

I. General information

NPI: 1194852590
Provider Name (Legal Business Name): PROGRESS VALLEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E 80TH ST
BLOOMINGTON MN
55420-1426
US

IV. Provider business mailing address

1100 E 80TH ST
BLOOMINGTON MN
55420-1426
US

V. Phone/Fax

Practice location:
  • Phone: 952-956-3100
  • Fax: 612-869-3225
Mailing address:
  • Phone: 952-956-3100
  • Fax: 612-869-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number801980-1-CDT
License Number StateMN

VIII. Authorized Official

Name: DR. JARED BOSTROM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DMFT, LMFT, LADC
Phone: 952-956-3101