Provider Demographics
NPI:1497760078
Name:PROACT, INC.
Entity Type:Organization
Organization Name:PROACT, INC.
Other - Org Name:PROACT - EAGAN, RED WING, ZUMBROTA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DITSCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-686-0312
Mailing Address - Street 1:3195 NEIL ARMSTRONG BLVD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2256
Mailing Address - Country:US
Mailing Address - Phone:651-686-0405
Mailing Address - Fax:651-686-0312
Practice Address - Street 1:3195 NEIL ARMSTRONG BLVD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2256
Practice Address - Country:US
Practice Address - Phone:651-686-0405
Practice Address - Fax:651-686-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services