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General NPI Number Information
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NPI Number | 1487015194
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Entity Type | Organization
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Legal Business Name | DEKALB BEHAVIORAL HEALTH FOUNDATION, INC.
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Dates
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Enumeration Date | 03/09/2016
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 100 S LATHAM ST STE 204 DASA
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City | SANDWICH
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State | IL
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Zip | 60548
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Country | US
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Telephone | 815-786-7544
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1109
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City | DEKALB
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State | IL
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Zip | 60115-7109
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Country | US
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Telephone | 815-786-7544
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FINACE
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Name | CHRISTINE ZYDEK
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Credential |
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Telephone | 815-748-2986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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