NPIMap

Organization Active NPI

Hazelden Betty Ford Foundation

Doing business as Hazelden Menasha

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Menasha, WI
National Provider Identifier
1669194932
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
HAZELDEN BETTY FORD FOUNDATION
Doing business as
Hazelden Menasha
Practice address
677 Brighton Beach Rd
Menasha, WI 54952-2903
Phone
(800) 257-7800
NPI assigned
Sep 14, 2022
Organization subpart
Yes
Parent organization
HAZELDEN BETTY FORD FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ashley Gibson
Title
VP Payer Relations
Phone
(651) 213-4519

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

677 Brighton Beach Rd
Menasha, WI 54952-2903

Mailing address

15251 Pleasant Valley Rd
Center City, MN 55012-9640
Phone (651) 213-4881

Other names 1

  • Hazelden Menasha Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hazelden Betty Ford Foundation16 organizations share this tax ID, including this one
Part of
Hazelden Betty Ford Foundation

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

677 Brighton Beach Rd
Menasha, WI 54952

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754438400000",
    "number": "1669194932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15251 PLEASANT VALLEY RD",
            "city": "CENTER CITY",
            "state": "MN",
            "postal_code": "550129640",
            "telephone_number": "651-213-4881",
            "fax_number": "651-213-4793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 BRIGHTON BEACH RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549522903",
            "telephone_number": "800-257-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZELDEN BETTY FORD FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAZELDEN BETTY FORD FOUNDATION",
        "enumeration_date": "2022-09-14",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "VP PAYER RELATIONS",
        "authorized_official_telephone_number": "651-213-4519"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hazelden Menasha",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Menasha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.