Ben Gordon Center | |
21193 Malta Rd Bldg. A - U154 Malta IL 60150-9600 | |
(815) 756-4875 | |
(815) 756-2944 |
Full Name | Ben Gordon Center |
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Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
Location | 21193 Malta Rd, Malta, 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 |
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Ben Gordon Center 21193 Malta Rd Bldg. A - U154 Malta IL 60150-9600 Ph: (815) 756-4875 | Ben Gordon Center 21193 Malta Rd Bldg. A - U154 Malta IL 60150-9600 Ph: (815) 756-4875 |
NPI Number | 1457654295 |
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Provider Enumeration Date | 12/17/2010 |
Last Update Date | 12/17/2010 |
Identifier | Type | State | Issuer |
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1457654295 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | A0254001A (Illinois) | Primary |