Doctor Name: | MICHAEL J BYDAL |
NPI Number: | 1477720258 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BUSINESS OWNER |
License Number: | 1046738-1-CDT |
Business Practice Address: | 1111 Gateway Dr Ne East Grand Forks, MN - 567212620 |
Business Phone Number: | 2187930420 |
Business Fax Number: | 2187930424 |
Mailing Address: | 1111 Gateway Dr Ne, EAST GRAND FORKS |
State: | MN |
Postal Code: | 567212620 |
Phone Number: | 2187930420 |
Fax Number: | 2187930424 |
NPI Enumeration Date: | 05/12/2008 |
NPI Last Update Date: | 05/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | 1046738-1-CDT |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |