Provider Demographics
NPI:1649937392
Name:HAZELDEN BETTY FORD FOUNDATION
Entity type:Organization
Organization Name:HAZELDEN BETTY FORD FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL CONTRACTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:TRANBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-213-4881
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:651-213-4881
Mailing Address - Fax:
Practice Address - Street 1:14001 E ILIFF AVE STE 120
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1417
Practice Address - Country:US
Practice Address - Phone:844-239-8389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAZELDEN BETTY FORD FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder