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General NPI Number Information
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NPI Number | 1245397959
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Entity Type | Organization
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Legal Business Name | HAZELDEN CHICAGO
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 867 N DEARBORN ST
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City | CHICAGO
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State | IL
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Zip | 60610-3310
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Country | US
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Telephone | 800-257-7800
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Fax | 312-943-3530
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Provider Business Mailing Address
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Address Line | 867 N DEARBORN ST
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City | CHICAGO
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State | IL
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Zip | 60610-3310
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Country | US
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Telephone | 800-257-7810
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Fax | 312-943-3530
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Authorized Official
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Title or Position | VP PAYER RELATIONS
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Name | ASHLEY GIBSON
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Credential |
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Telephone | 651-213-4519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | A-9403-0001-P
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License Number State | IL
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