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General NPI Number Information
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NPI Number | 1356117964
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Entity Type | Organization
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Legal Business Name | PROGRESS VALLEY, INC.
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1100 E 80TH ST
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City | BLOOMINGTON
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State | MN
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Zip | 55420-1426
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Country | US
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Telephone | 612-869-3223
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 E 80TH ST
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City | BLOOMINGTON
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State | MN
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Zip | 55420-1426
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Country | US
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Telephone | 612-869-3223
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF MENTAL HEALTH
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Name | MR. KYLE WILLIAM ROSS
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Credential |
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Telephone | 612-869-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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