Provider Demographics
NPI:1346406519
Name:COUNTY OF DUPAGE DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:COUNTY OF DUPAGE DEPARTMENT OF HEALTH
Other - Org Name:DUPAGE COUNTY HEALTH DEPARTMENT - CAP II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FORKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-682-7400
Mailing Address - Street 1:111 N COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3977
Mailing Address - Country:US
Mailing Address - Phone:630-682-7400
Mailing Address - Fax:
Practice Address - Street 1:438 N. ARDMORE AVE.
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-1763
Practice Address - Country:US
Practice Address - Phone:630-682-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF DUPAGE DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-06
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM0801X, 320800000X, 261QM0801X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36 60006553038Medicaid
IL201614Medicare UPIN
IL201614Medicare UPIN
IL60002664OtherMEDICARE B RAILROAD