MICHAEL J BYDAL (NPI# 1477720258) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477720258 |
| Entity Type | Individual |
| Full Name | MICHAEL J BYDAL |
| Credential | BUSINESS OWNER |
| Practice Address |
1111 Gateway Dr Ne East Grand Forks MN 56721-2620 |
| Practice Telephone | 2187930420 |
| Practice Fax Number | 2187930424 |
| Mailing Telephone | 2187930420 |
| Mailing Fax Number | 2187930424 |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2008-05-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 1046738-1-CDT | MN | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | MHCP PROVIDER NUMBER | 935555300 | 01 |
| Street Address |
1111 GATEWAY DR NE |
| City | EAST GRAND FORKS |
| State | MN |
| Zip Code | 56721-2620 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598172629 | Jami Bobby | Marriage & Family Therapist | 1111 Gateway Dr Ne, East Grand Forks, MN 56721-2620 | 2014-07-21 |
| 1306277645 | Douglas Place Treatment Center LLC | Substance Abuse Rehabilitation Facility | 1111 Gateway Dr Ne, East Grand Forks, MN 56721-2620 | 2013-12-12 |
| 1114194719 | Nancy K Kujawa | Counselor | 1111 Gateway Dr Ne, East Grand Forks, MN 56721-2620 | 2008-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902421316 | Altru Health System | Assisted Living Facility | 605 5th Ave Nw, East Grand Forks, MN 56721 | 2020-06-11 |
| 1770916025 | Erika Marie Severson | Counselor | 1422 Central Ave Nw, East Grand Forks, MN 56721 | 2013-08-09 |
| 1871823021 | Stephanie Hinkle | Physician Assistant | 621 Central Ave Nw, East Grand Forks, MN 56721 | 2010-01-12 |
| 1437355393 | Sanford Clinic North | Family Medicine | 929 Central Avenue, East Grand Forks, MN 56721 | 2007-06-26 |
| 1821290826 | Andrea M Auch | Physical Therapist | 607 Demers Ave - Altru Clinic I East Grand Forks, East Grand Forks, MN 56721 | 2007-06-01 |
| 1891912812 | East Grand Forks Dental Care | Dentist | 22 4th St. Ne, East Grand Forks, MN 56721 | 2007-04-19 |
| 1457423220 | Jeffrey S Haney | Physical Therapist | 607 Demers Ave - Altru Clinic / East Grand Forks, East Grand Forks, MN 56721 | 2006-11-15 |
| 1679514285 | Jon Edwin Bradbury | Family Medicine | 929 Central Ave. Nw, East Grand Forks, MN 56721 | 2006-06-08 |
| 1891215836 | Abbey L Anderson | Nurse Practitioner | 625 Demers Ave, East Grand Forks, MN 56721 | 2017-06-21 |
| 1114314358 | Mridu Gandhi | Family Medicine | 929 Central Ave Nw, East Grand Forks, MN 56721 | 2015-04-24 |
| Find all providers in zip 56721 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| 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. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407905136 | Riverview Healthcare Association | Substance Abuse Rehabilitation Facility | 210 Gateway Dr Ne Ste 4, East Grand Forks, MN 56721-1623 | 2007-01-10 |
| 1306277645 | Douglas Place Treatment Center LLC | Substance Abuse Rehabilitation Facility | 1111 Gateway Dr Ne, East Grand Forks, MN 56721-2620 | 2013-12-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255948584 | Sober Living Connection | Substance Abuse Rehabilitation Facility | 11115 Minnetonka Blvd, Hopkins, MN 55305 | 2020-09-30 |
| 1730791393 | Crecer Services | Substance Abuse Rehabilitation Facility | 220 Robert St S Ste 103, Saint Paul, MN 55107-1626 | 2020-08-17 |
| 1801405584 | Bridge Recovery LLC | Substance Abuse Rehabilitation Facility | 1485 10th Avenue Ne, Sauk Rapids, MN 56379-9838 | 2020-07-28 |
| 1710505821 | Rrecovery Services | Substance Abuse Rehabilitation Facility | 867 Pierce Butler Rte, Saint Paul, MN 55104-1522 | 2020-07-06 |
| 1912520966 | Avenues, LLC | Substance Abuse Rehabilitation Facility | 1990 Suburban Ave Ste 2000, Saint Paul, MN 55119-7001 | 2020-05-26 |
| 1962022939 | Valley View Recovery Center Inc. | Substance Abuse Rehabilitation Facility | 31591 64th Ave, Cannon Falls, MN 55009-4296 | 2020-04-20 |
| 1801420039 | Recovery Center LLC | Substance Abuse Rehabilitation Facility | 109 W James St, Paynesville, MN 56362-1216 | 2020-02-26 |
| 1336772425 | Northern Minnesota Addiction Wellness Center | Substance Abuse Rehabilitation Facility | 4851 Stacy Ann Dr Nw, Bemidji, MN 56601 | 2020-02-17 |
| 1386277622 | Community of Recovering People | Substance Abuse Rehabilitation Facility | 1221 Wayzata Blvd E, Wayzata, MN 55391-1942 | 2020-02-14 |
| 1992366645 | One Touch of Christ Evangelistic Ministries | Substance Abuse Rehabilitation Facility | 5701 Shingle Creek Pkwy Ste 650, Brooklyn Center, MN 55430-2492 | 2019-06-24 |
| Find all providers with the same taxonomy | ||||
| City | EAST GRAND FORKS |
| Zip Code | 56721 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.