Healthcare Provider Details

I. General information

NPI: 1023011798
Provider Name (Legal Business Name): DEKALB COUNTY GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 10/11/2024
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N ANNIE GLIDDEN RD
DEKALB IL
60115-1207
US

IV. Provider business mailing address

2600 N ANNIE GLIDDEN RD
DEKALB IL
60115-1207
US

V. Phone/Fax

Practice location:
  • Phone: 815-758-2477
  • Fax: 815-217-0451
Mailing address:
  • Phone: 815-758-2477
  • Fax: 815-217-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0044321
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0044321
License Number StateIL

VIII. Authorized Official

Name: MR. BART J BECKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 815-758-2477