Provider Demographics
NPI:1023011798
Name:DEKALB COUNTY GOVERNMENT
Entity Type:Organization
Organization Name:DEKALB COUNTY GOVERNMENT
Other - Org Name:DEKALB COUNTY REHAB AND NURSING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUCHENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-217-0303
Mailing Address - Street 1:2600 N ANNIE GLIDDEN RD
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-1207
Mailing Address - Country:US
Mailing Address - Phone:815-758-2477
Mailing Address - Fax:815-217-0451
Practice Address - Street 1:2600 N ANNIE GLIDDEN RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-1207
Practice Address - Country:US
Practice Address - Phone:815-758-2477
Practice Address - Fax:815-217-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0044321314000000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0044321OtherIL DEPT. OF PUBLIC HEALTH
IL=========804OtherIDPA DME SUPPLY ID NUMBER
IL=========003Medicaid
IL14 5547Medicare ID - Type UnspecifiedMEDICARE ID NUMBER