Provider Demographics
NPI:1518094937
Name:PROGRESS VALLEY, INC.
Entity Type:Organization
Organization Name:PROGRESS VALLEY, INC.
Other - Org Name:PROGRESS VALLEY MENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:612-869-3223
Mailing Address - Street 1:3033 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2924
Mailing Address - Country:US
Mailing Address - Phone:612-827-2517
Mailing Address - Fax:
Practice Address - Street 1:3033 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2924
Practice Address - Country:US
Practice Address - Phone:612-827-2517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN801979-1-CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility