Healthcare Provider Details

I. General information

NPI: 1568529261
Provider Name (Legal Business Name): HAZELDEN BETTY FORD FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15251 PLEASANT VALLEY RD
CENTER CITY MN
55012-9640
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: 651-213-4547
Mailing address:
  • Phone: 800-257-7800
  • Fax: 651-213-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number800-997-3-
License Number StateMN

VIII. Authorized Official

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