Provider Demographics
NPI:1245652569
Name:BOB HAYES ADDICTION SERVICES
Entity type:Organization
Organization Name:BOB HAYES ADDICTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAC
Authorized Official - Phone:701-838-1422
Mailing Address - Street 1:1809 S BROADWAY
Mailing Address - Street 2:SUITE G
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6567
Mailing Address - Country:US
Mailing Address - Phone:701-838-1422
Mailing Address - Fax:701-838-1423
Practice Address - Street 1:1809 S BROADWAY
Practice Address - Street 2:SUITE G
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6567
Practice Address - Country:US
Practice Address - Phone:701-838-1422
Practice Address - Fax:701-838-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1428261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder