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Organization

PROGRESS VALLEY, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JARED BOSTROM DMFT, LMFT, LADC (CHIEF EXECUTIVE OFFICER)
(952) 956-3101
Entity
Organization

Contact information

Practice address
1100 E 80TH ST, BLOOMINGTON, MN 55420-1426
(952) 956-3100
(612) 869-3225
Mailing address
1100 E 80TH ST, BLOOMINGTON, MN 55420-1426
(952) 956-3100
(612) 869-3225

Taxonomy

Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
801980-1-CDT
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
876255400
MHCP PROVIDER NUMBER
MN
Enumeration date
02/27/2007
Last updated
05/05/2026
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