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NPI Code Detail

MEDICARE: HAZELDEN BETTY FORD FOUNDATION

MEDICARE: HAZELDEN BETTY FORD FOUNDATION
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
1323P00000XPsychiatric Residential Treatment Facility
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
4324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1831216225
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAZELDEN BETTY FORD FOUNDATION
Provider Business Mailing Address
First Line : 15251 PLEASANT VALLEY RD
Second Line :
City : CENTER CITY
State : MN
Zip : 55012-9640
Country : US
Telephone Number : 800-257-7800
Fax Number :
Provider Business Practice Location Address
First Line : 11505 36TH AVE N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55441-2304
Country : US
Telephone Number : 800-257-7800
Fax Number :
Authorized Official
Title or Position : VP PAYER RELATIONS
Name : ASHLEY GIBSON
Credential :
Telephone Number : 651-213-4519
Provider Enumeration Date : 03/23/2007
Last Update Date : 05/16/2025

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Directions to “HAZELDEN BETTY FORD FOUNDATION ” Practice Location

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