DEKALB BEHAVIORAL HEALTH FOUNDATION, INC. (NPI# 1255703450) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255703450 |
| Entity Type | Organization |
| Organization Name | DEKALB BEHAVIORAL HEALTH FOUNDATION, INC. |
| Other Organization Name | NORTHWESTERN MEDICINE BEN GORDON CENTER |
| Practice Address |
12 Health Services Dr Dekalb IL 60115 |
| Mailing Address |
Po Box 1109 Dekalb IL 60115-7109 |
| Practice Telephone | 8157564875 |
| Mailing Telephone | 8157564875 |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2018-07-23 |
| Authorized Official Name | BETTYJO FORTUNE (FINANCIAL ASSESSOR) |
| Authorized Official Telephone | 8157564875 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 1255703450 | 05 |
| Other Name | Type Code |
|---|---|
| Northwestern Medicine Ben Gordon Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316304058 | Dekalb Behavioral Health Foundation, Inc. | Clinic/Center | 100 S Latham St Ste 204, Sandwich, IL 60548 | 2016-01-26 |
| 1659868859 | Dekalb Behavioral Health Foundation, Inc. | Clinic/Center | 631 S 1st St, Dekalb, IL 60115 | 2018-04-13 |
| 1487015194 | Dekalb Behavioral Health Foundation, Inc. | Clinic/Center | 100 S Latham St Ste 204, Dasa, Sandwich, IL 60548 | 2016-03-09 |
| 1437519345 | Dekalb Behavioral Health Foundation, Inc. | Clinic/Center | 12 Health Services Dr, Dasa, Dekalb, IL 60115 | 2016-03-04 |
| 1306203856 | Dekalb Behavioral Health Foundation, Inc. | Clinic/Center | 631 S 1st St, Dekalb, IL 60115 | 2016-01-27 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | DEKALB BEHAVIORAL HEALTH FOUNDATION, INC. | 12 Health Services Drive, Dekalb, IL 60115-9637 |
| Street Address |
12 HEALTH SERVICES DR |
| City | DEKALB |
| State | IL |
| Zip Code | 60115 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144393497 | Amylynn M Weiten | Counselor | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2006-11-16 |
| 1952900375 | Brianna Rae Johnson | Counselor | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-10-19 |
| 1215543111 | Rhyann Brianna Locke | Social Worker | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-09-17 |
| 1952925182 | Mariah Anne Thompson | Counselor | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-06-03 |
| 1376167734 | Hannah Grace Brennan | Counselor | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-06-02 |
| 1619590981 | Samantha Nikole Gudmunson | Registered Nurse | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-05-21 |
| 1992326151 | Dianna Huttunen | Case Management | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-04-29 |
| 1558982702 | Kathleen C Wilkerson | Case Management | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-04-29 |
| 1457983108 | Andrew Ryan Phillips | Counselor | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-02-11 |
| 1225670219 | Bonn Christian Cruz | Counselor | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2019-10-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598372179 | Megan Erhart | Counselor | 304 N. 6th Street, Dekalb, IL 60115 | 2020-09-28 |
| 1689141616 | Stephanie Klewin | Psychologist | 631 S 1st Street, Dekalb, IL 60115 | 2018-10-29 |
| 1164902219 | Kimberly Ann Hart | Counselor | 290 N. Annie Glidden Drive, Gh 416, Niu, Dekalb, IL 60115 | 2018-08-17 |
| 1497235824 | Cory David Michael Hayden | Specialist/Technologist | 175 Yordon Center (niu Athletic Training), Dekalb, IL 60115 | 2018-08-15 |
| 1154807808 | Michael John Borak | Pharmacist | 975 S Annie Glidden Road, Schnucks Market Inc, Dekalb, IL 60115 | 2018-07-16 |
| 1184125841 | Candace Schroeffel | Student in an Organized Health Care Education/Training Program | 520 Garden Rd, Dekalb, IL 60115 | 2018-02-27 |
| 1033627583 | Hannah M Studebaker | Massage Therapist | 3266 Sycamore Road, Dekalb, IL 60115 | 2018-01-18 |
| 1649700238 | Jennifer Mangino | Behavioral Analyst | 138 Berkshire Dr, Dekalb, IL 60115 | 2017-06-15 |
| 1003346628 | Victoria Tullock | Counselor | 631 South First St., Dekalb, IL 60115 | 2017-06-15 |
| 1194263848 | Brianna Kraft | Specialist/Technologist | 900 Crane Dr, Dekalb, IL 60115 | 2017-02-02 |
| Find all providers in zip 60115 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528556669 | Associaiton for Individual Development | Clinic/Center | 304 N 6th St Ste C, Dekalb, IL 60115-3484 | 2018-04-24 |
| 1972788925 | Community Support Program/reality House | Clinic/Center | 631 S 1st St, Dekalb, IL 60115-4117 | 2008-01-08 |
| 1750327003 | Ben Gordon Center | Clinic/Center | 12 Health Services Drive, Dekalb, IL 60115 | 2006-06-22 |
| 1184154007 | Family Service Agency of Dekalb County, Inc. | Clinic/Center | 14 Health Services Dr, Dekalb, IL 60115-9637 | 2017-06-13 |
| 1306203856 | Dekalb Behavioral Health Foundation, Inc. | Clinic/Center | 631 S 1st St, Dekalb, IL 60115 | 2016-01-27 |
| 1700037512 | Ben Gordon Center | Clinic/Center | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2008-10-10 |
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|---|---|---|---|---|
| 1225639990 | Mindy Forman, Psyd, LLC | Clinic/Center | 1020 Milwaukee Ave Ste 110, Deerfield, IL 60015-3555 | 2020-11-07 |
| 1346840295 | Stopka Professional Counseling LLC | Clinic/Center | 13125 Steeplechase Dr, New Lenox, IL 60451-1320 | 2020-10-29 |
| 1346848785 | Wellness Hearted Therapy LLC | Clinic/Center | 2675 S Cedar Glen Dr, Arlington Heights, IL 60005-5303 | 2020-10-16 |
| 1457959256 | Association for Individual Development | Clinic/Center | 708 N Bridge St, Yorkville, IL 60560-1105 | 2020-10-14 |
| 1285231555 | Association for Individual Development | Clinic/Center | 236 W Crystal Lake Ave, Crystal Lake, IL 60014-5847 | 2020-10-08 |
| 1386241123 | Envision Unlimited | Clinic/Center | 1801 N Spaulding Ave, Chicago, IL 60647-4926 | 2020-10-05 |
| 1881291789 | Jessica Weisbach, LLC | Clinic/Center | 2257 N Kedzie Blvd Apt 3, Chicago, IL 60647-2561 | 2020-10-04 |
| 1619574803 | Envision Unlimited | Clinic/Center | 2124 W 82nd Pl, Chicago, IL 60620-5358 | 2020-10-01 |
| 1144827320 | Envision Unlimited | Clinic/Center | 4919 N Clark St, Chicago, IL 60640-3514 | 2020-10-01 |
| 1194322370 | Envision Unlimited | Clinic/Center | 4911 S Hoyne Ave, Chicago, IL 60609-4721 | 2020-10-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.