DEKALB BEHAVIORAL HEALTH FOUNDATION, INC. (NPI# 1316304058) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316304058 |
| Entity Type | Organization |
| Organization Name | DEKALB BEHAVIORAL HEALTH FOUNDATION, INC. |
| Other Organization Name | NORTHWESTERN MEDICINE BEN GORDON CENTER |
| Practice Address |
100 S Latham St Ste 204 Sandwich IL 60548 |
| Mailing Address |
Po Box 1109 Dekalb IL 60115-7109 |
| Practice Telephone | 8157867544 |
| Mailing Telephone | 8157867544 |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2018-07-23 |
| Authorized Official Name | CHRISTINE ZYDEK (DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 8157561521 |
| Is Organization Subpart | Y |
| Parent Organization Name | DEKALB BEHAVIORAL HEALTH FOUNDATION, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
A-5202-0001-A | IL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Northwestern Medicine Ben Gordon Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1255703450 | Dekalb Behavioral Health Foundation, Inc. | Clinic/Center | 12 Health Services Dr, Dekalb, IL 60115 | 2015-10-27 |
| 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 |
100 S LATHAM ST STE 204 |
| City | SANDWICH |
| State | IL |
| Zip Code | 60548 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487015194 | Dekalb Behavioral Health Foundation, Inc. | Clinic/Center | 100 S Latham St Ste 204, Dasa, Sandwich, IL 60548 | 2016-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366954166 | Northern Rehabilitation and Sports Medicine Associates | Physical Therapist | 523 E. Railroad Street, Suite A, Sandwich, IL 60548 | 2017-11-02 |
| 1538683040 | Ariel Eads | Counselor | 207 E Church St Unit A, Sandwich, IL 60548 | 2017-07-27 |
| 1093169138 | Kimberly S Miner | Acupuncturist | 100 South Latham Street, Suite 103b, Sandwich, IL 60548 | 2016-04-14 |
| 1215006200 | Robert C Lerohl | Dentist | 430 S. Dayton Street, Sandwich, IL 60548 | 2006-11-06 |
| 1609950641 | Joseph Jimenez | Chiropractor | 823 E Church St, Sandwich, IL 60548 | 2006-10-25 |
| 1104919703 | Pharmacy Operations, Inc | Pharmacy | 142 Indian Springs Drive, Sandwich, IL 60548 | 2006-10-02 |
| 1902911076 | Jason Lee Robinson | Physical Therapist | 710 E Railroad St, Sandwich, IL 60548 | 2006-08-20 |
| 1982719209 | Anchor Dental Center Ltd | Dentist | 100 S Latham St, Sandwich, IL 60548 | 2006-08-19 |
| 1376566745 | Sandwich Community Fire Protection District | Ambulance | 310 E Railroad St, Sandwich, IL 60548 | 2006-07-25 |
| 1609355031 | Sarah Elizabeth Swygart | Counselor | 207 E Church St Unit A, Sandwich, IL 60548 | 2018-08-07 |
| Find all providers in zip 60548 | ||||
| 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 |
|---|---|---|---|---|
| 1598940546 | Ben Gordon Center | Clinic/Center | 100 S Latham St, Suite 204, Sandwich, IL 60548-2276 | 2008-01-08 |
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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.