Healthcare Provider Details

I. General information

NPI: 1508261025
Provider Name (Legal Business Name): HAZELDEN BETTY FORD FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SANTA MONICA BLVD SUITE 310
LOS ANGELES CA
90025-4768
US

IV. Provider business mailing address

15251 PLEASANT VALLEY RD
CENTER CITY MN
55012-9640
US

V. Phone/Fax

Practice location:
  • Phone: 800-257-7800
  • Fax:
Mailing address:
  • Phone: 800-257-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY GIBSON
Title or Position: VP PAYER RELATIONS
Credential:
Phone: 651-213-4519