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Organization
BEN GORDON CENTER
Active
Organization
BEN GORDON CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETTYJO BIEBERITZ (CONTRACT COORDINATOR)
(815) 756-4875
Entity
Organization
Contact information
Practice address
631 S 1ST ST, DEKALB, IL 60115-4117
(815) 756-8501
(815) 756-5849
Mailing address
12 HEALTH SERVICES DR, DEKALB, IL 60115-9637
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
149017667
IL
Other
Enumeration date
06/05/2015
Last updated
07/14/2015
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