DEKALB BEHAVIORAL HEALTH FOUNDATION, INC. (NPI# 1306203856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306203856 |
| Entity Type | Organization |
| Organization Name | DEKALB BEHAVIORAL HEALTH FOUNDATION, INC. |
| Other Organization Name | NORTHWESTERN MEDICINE BEN GORDON CENTER |
| Practice Address |
631 S 1st St Dekalb IL 60115 |
| Mailing Address |
Po Box 1109 Dekalb IL 60115-7109 |
| Practice Telephone | 8157568501 |
| Mailing Telephone | 8157568501 |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2018-07-23 |
| Authorized Official Name | CHRISTINE ZYDEK (DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 8157482986 |
| 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 |
|---|---|---|---|---|
| 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 |
| 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 |
631 S 1ST ST |
| City | DEKALB |
| State | IL |
| Zip Code | 60115 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972788925 | Community Support Program/reality House | Clinic/Center | 631 S 1st St, Dekalb, IL 60115-4117 | 2008-01-08 |
| 1164023719 | Amanda Marie Reeves | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2020-11-02 |
| 1184223141 | Kendra Scrutchens | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2020-10-21 |
| 1073137519 | Emily Nicole Taylor | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2020-06-01 |
| 1871117564 | Dawn Magnuson | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2020-05-29 |
| 1376164822 | Jasmine Alexis Sronkoski | Social Worker | 631 S 1st St, Dekalb, IL 60115-4117 | 2020-05-06 |
| 1831738616 | Alissa E Taylor | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2019-12-27 |
| 1912546995 | Melissa Ybarra-robinson | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2019-12-23 |
| 1144868357 | Bethany Ann Johnson | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2019-12-18 |
| 1407401086 | Dominique Marie Smith | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2019-08-09 |
| 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 |
| 1255703450 | Dekalb Behavioral Health Foundation, Inc. | Clinic/Center | 12 Health Services Dr, Dekalb, IL 60115 | 2015-10-27 |
| 1700037512 | Ben Gordon Center | Clinic/Center | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2008-10-10 |
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| 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 |
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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.