Organization
HAZELDEN BETTY FORD FOUNDATION
Active
Organization
HAZELDEN BETTY FORD FOUNDATION
Active
Other names
Hazelden Plymouth
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY GIBSON (VP PAYER RELATIONS)
(651) 213-4519
Entity
Organization
Contact information
Practice address
11505 36TH AVE N, PLYMOUTH, MN 55441-2304
(800) 257-7800
Mailing address
15251 PLEASANT VALLEY RD, CENTER CITY, MN 55012-9640
(800) 257-7800
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/23/2007
Last updated
05/16/2025
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