Provider Demographics
NPI:1891846325
Name:HAZELDEN BETTY FORD FOUNDATION
Entity Type:Organization
Organization Name:HAZELDEN BETTY FORD FOUNDATION
Other - Org Name:BETTY FORD CENTER
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 1:39407 VISTA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3283
Mailing Address - Country:US
Mailing Address - Phone:800-257-7800
Mailing Address - Fax:
Practice Address - Street 1:39407 VISTA DEL SOL
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3283
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:2007-01-12
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000049324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility