| Ben Gordon Center | |
|
631 S 1st St Dekalb IL 60115-4117 | |
| (815) 756-8501 | |
| (815) 756-5849 |
| Full Name | Ben Gordon Center |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 631 S 1st St, Dekalb, Illinois |
| Authorized Official Name and Position | Michael Flora (CEO/PRESIDENT) |
| Authorized Official Contact | 8157564875 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ben Gordon Center 631 S 1st St Dekalb IL 60115-4117 Ph: (815) 756-8501 | Ben Gordon Center 631 S 1st St Dekalb IL 60115-4117 Ph: (815) 756-8501 |
| NPI Number | 1972788925 |
|---|---|
| Provider Enumeration Date | 01/08/2008 |
| Last Update Date | 10/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972788925 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | A0254001A (Illinois) | Primary |
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