MEDICARE: PROGRESS VALLEY, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	801979-1-CDT	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	855856600	OTHER	MN	MHCP PROVIDER NUMBER

General Provider Information

NPI Number	:	1518094937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESS VALLEY, INC.

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

Provider Business Practice Location Address
First Line	:	3033 GARFIELD AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2924
Country	:	US
Telephone Number	:	612-827-2517
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	05/06/2026

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Directions to “PROGRESS VALLEY, INC. ” Practice Location

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