Provider Demographics
NPI:1912064635
Name:HAZELDEN NEW YORK
Entity Type:Organization
Organization Name:HAZELDEN NEW YORK
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:651-213-4724
Mailing Address - Street 1:322 8TH AVE
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-8001
Mailing Address - Country:US
Mailing Address - Phone:800-257-7810
Mailing Address - Fax:212-420-9664
Practice Address - Street 1:322 8TH AVE
Practice Address - Street 2:12TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-8001
Practice Address - Country:US
Practice Address - Phone:800-257-7810
Practice Address - Fax:212-420-9664
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
NY261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder