| NPI | 1669194932 |
|---|---|
| Other Name | HAZELDEN BETTY FORD - MENASHA |
| Entity Type | Organization |
| Authorized Contact | JON TRANBY Contract Manager 651-213-4881 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2022-09-14 |
| Last Update Date | 2022-09-14 |