Provider Demographics
NPI:1457334203
Name:DEKALB COUNTY FINANCE OFFICE
Entity Type:Organization
Organization Name:DEKALB COUNTY FINANCE OFFICE
Other - Org Name:DEKALB COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-758-6673
Mailing Address - Street 1:2550 NORTH ANNIE GLIDDEN ROAD
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115
Mailing Address - Country:US
Mailing Address - Phone:815-758-6673
Mailing Address - Fax:815-748-2478
Practice Address - Street 1:2550 N ANNIE GLIDDEN RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-1297
Practice Address - Country:US
Practice Address - Phone:815-758-6673
Practice Address - Fax:815-748-2478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1001205251E00000X
IL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9616OtherBLUE CROSS BLUE SHIELD
IL147025OtherMEDICARE LEGACY NUMBER
IL=========001Medicaid
IL147025OtherMEDICARE LEGACY NUMBER
IL=========001Medicaid