NPIMap

Organization Active NPI

Progress Valley, Inc.

  • Substance Abuse Rehabilitation Facility
  • Roseville, MN
National Provider Identifier
1225894819
Registry record updated May 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
PROGRESS VALLEY, INC.
Practice address
2675 Long Lake Rd Ste 125
Roseville, MN 55113-2823
Phone
(952) 956-3100
NPI assigned
Feb 22, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jared Bostrom, DMFT, LMFT, LADC
Title
Chief Executive Officer
Phone
(952) 956-3101

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

2675 Long Lake Rd Ste 125
Roseville, MN 55113-2823

Mailing address

1100 E 80TH St
Bloomington, MN 55420-1426
Phone (952) 956-3100

National Provider Directory

National Provider Directory
Tax ID family
Progress Valley Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2675 Long Lake Rd
Ste 125
Roseville, MN 55113
Phone (952) 564-3000

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778025600000",
    "number": "1225894819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 E 80TH ST",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554201426",
            "telephone_number": "952-956-3100",
            "fax_number": "612-869-3225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2675 LONG LAKE RD STE 125",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132823",
            "telephone_number": "952-956-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESS VALLEY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-22",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A",
        "authorized_official_last_name": "BOSTROM",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "952-956-3101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMFT, LMFT, LADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.