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NPI Code Detail

MEDICARE: HAZELDEN CHICAGO

MEDICARE: HAZELDEN CHICAGO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/CenterA-9403-0001-PIL

General Provider Information

NPI Number : 1245397959
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAZELDEN CHICAGO
Provider Business Mailing Address
First Line : 867 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60610-3310
Country : US
Telephone Number : 800-257-7810
Fax Number : 312-943-3530
Provider Business Practice Location Address
First Line : 867 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60610-3310
Country : US
Telephone Number : 800-257-7800
Fax Number : 312-943-3530
Authorized Official
Title or Position : VP PAYER RELATIONS
Name : ASHLEY GIBSON
Credential :
Telephone Number : 651-213-4519
Provider Enumeration Date : 01/02/2007
Last Update Date : 05/16/2025

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Directions to “HAZELDEN CHICAGO ” Practice Location

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