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General NPI Number Information
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NPI Number | 1801743612
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE INDIVIDUAL RESOURCES INC
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Dates
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Enumeration Date | 03/11/2026
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 220 ROBERT ST S STE 206
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City | SAINT PAUL
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State | MN
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Zip | 55107-1692
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Country | US
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Telephone | 612-749-3309
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Fax | 612-749-3309
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Provider Business Mailing Address
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Address Line | 2147 UNIVERSITY AVE W STE 206
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City | SAINT PAUL
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State | MN
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Zip | 55114-1327
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Country | US
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Telephone | 612-749-3309
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Fax | 612-749-3309
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Authorized Official
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Title or Position | DIRECTOR OF SERVICES
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Name | DR. RICHARD BOLADE ONI
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Credential |
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Telephone | 612-749-3309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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