Provider Demographics
NPI:1902452246
Name:DEKALB COUNTY GOVERNMENT
Entity Type:Organization
Organization Name:DEKALB COUNTY GOVERNMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:VITTORIO
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:815-217-0310
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:815-217-0310
Practice Address - Fax:815-217-0451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEKALB COUNTY GOVERNMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1023011798OtherTIN