Provider Demographics
NPI:1508261025
Name:HAZELDEN BETTY FORD FOUNDATION
Entity Type:Organization
Organization Name:HAZELDEN BETTY FORD FOUNDATION
Other - Org Name:BETTY FORD CENTER AT WEST LOS ANGELES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:STUEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-213-4729
Mailing Address - Street 1:15251 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CENTER CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55012-9640
Mailing Address - Country:US
Mailing Address - Phone:800-257-7800
Mailing Address - Fax:
Practice Address - Street 1:10700 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4768
Practice Address - Country:US
Practice Address - Phone:800-257-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility