Provider Demographics
NPI:1245397959
Name:HAZELDEN CHICAGO
Entity Type:Organization
Organization Name:HAZELDEN CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RANUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-213-7424
Mailing Address - Street 1:867 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3310
Mailing Address - Country:US
Mailing Address - Phone:800-257-7810
Mailing Address - Fax:312-943-3530
Practice Address - Street 1:867 N DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3310
Practice Address - Country:US
Practice Address - Phone:800-257-7810
Practice Address - Fax:312-943-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-9403-0001-P261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder