MEDICARE: PROGRESS VALLEY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1225894819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESS VALLEY, INC.

Provider Business Mailing Address
First Line	:	2675 LONG LAKE RD STE 125
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-2823
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2675 LONG LAKE RD STE 125
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-2823
Country	:	US
Telephone Number	:	952-956-3100
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR OF OPERATIONS
Name	:	AMBER M MICHALSKI
Credential	:
Telephone Number	:	952-956-3181

Provider Enumeration Date	:	02/22/2024
Last Update Date	:	02/22/2024

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