Healthcare Provider Details

I. General information

NPI: 1003080417
Provider Name (Legal Business Name): VOLUNTARY ACTION CENTER OF DEKALB COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 BETHANY RD
SYCAMORE IL
60178-3120
US

IV. Provider business mailing address

1606 BETHANY RD
SYCAMORE IL
60178-3120
US

V. Phone/Fax

Practice location:
  • Phone: 815-758-3932
  • Fax:
Mailing address:
  • Phone: 815-758-3932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: BARB MARIE PELAN
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 815-758-3932