NPIMap

Organization Active NPI

Hazelden Betty Ford Foundation

Doing business as Hazelden Plymouth

  • Substance Abuse Rehabilitation Facility
  • Plymouth, MN
National Provider Identifier
1831216225
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
HAZELDEN BETTY FORD FOUNDATION
Doing business as
Hazelden Plymouth
Practice address
11505 36TH Ave N
Plymouth, MN 55441-2304
Phone
(800) 257-7800
NPI assigned
Mar 23, 2007
Last updated
May 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Psychiatric Residential Treatment Facility 323P00000X NU
Substance Abuse Rehabilitation Facility 324500000X NU Primary

Addresses

Primary practice location

11505 36TH Ave N
Plymouth, MN 55441-2304

Mailing address

15251 Pleasant Valley Rd
Center City, MN 55012-9640
Phone (800) 257-7800

Other names 1

  • Hazelden Plymouth Doing business as

National Provider Directory

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

Other organizations with this tax ID 15

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

View all 15

Locations

11505 36th Ave N
Plymouth, MN 55441
Phone (763) 509-3800

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1831216225",
    "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": "800-257-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11505 36TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412304",
            "telephone_number": "800-257-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZELDEN BETTY FORD FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hazelden Plymouth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.