Provider Demographics
NPI:1255656161
Name:PROGRESSIVE INDIVIDUAL RESOURCES II
Entity Type:Organization
Organization Name:PROGRESSIVE INDIVIDUAL RESOURCES II
Other - Org Name:PROGRESSIVE INDIVIDUAL RESOURCES INC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BOLADE
Authorized Official - Last Name:ONI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LISW
Authorized Official - Phone:612-749-3309
Mailing Address - Street 1:220 ROBERT ST S STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-1692
Mailing Address - Country:US
Mailing Address - Phone:612-749-3309
Mailing Address - Fax:651-222-6567
Practice Address - Street 1:220 ROBERT ST S STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1692
Practice Address - Country:US
Practice Address - Phone:612-749-3309
Practice Address - Fax:651-222-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-03
Last Update Date:2010-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health