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General NPI Number Information
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NPI Number | 1912064635
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Entity Type | Organization
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Legal Business Name | HAZELDEN NEW YORK
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 322 8TH AVE 12TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10001-8001
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Country | US
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Telephone | 800-257-7810
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Fax | 212-420-9664
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Provider Business Mailing Address
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Address Line | 322 8TH AVE 12TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10001-8001
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Country | US
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Telephone | 800-257-7810
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Fax | 212-420-9664
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Authorized Official
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Title or Position | CFO
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Name | MICHAEL RANUM
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Credential |
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Telephone | 651-213-4724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State | NY
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