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Organization
BEN GORDON CENTER
Active
Organization
BEN GORDON CENTER
Active
Parent organization
BEN GORDON CENTER
Other names
Kid Care Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEN GORDON CENTER
Authorized official
MRS. KIMBERLY KRUPPENBACHER (CREDENTIALING COORDINATOR)
(815) 756-4875
Entity
Organization
Contact information
Practice address
12 HEALTH SERVICES DR, DEKALB, IL 60115-9637
(815) 756-4875
(815) 756-2944
Mailing address
12 HEALTH SERVICES DR, DEKALB, IL 60115-9637
(815) 756-4875
(815) 756-2944
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
A0254001A
IL
Other
Enumeration date
10/10/2008
Last updated
10/10/2008
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