MEDICARE: COUNTY OF DUPAGE DEPARTMENT OF HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201614	OTHER	IL	MEDICARE

General Provider Information

NPI Number	:	1134110786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF DUPAGE DEPARTMENT OF HEALTH

Provider Business Mailing Address
First Line	:	111 N COUNTY FARM RD
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-3977
Country	:	US
Telephone Number	:	630-682-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N COUNTY FARM RD
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-3977
Country	:	US
Telephone Number	:	630-682-7400
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ADAM FORKER
Credential	:
Telephone Number	:	630-682-7400

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	05/31/2023

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