Organization
BEN GORDON CENTER
Active
Parent organization
BEN GORDON CENTER
Other names
DASA Medicaid Provider
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEN GORDON CENTER
Authorized official
MR. MICHAEL FLORA (CEO/PRESIDENT)
(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
251S00000X
Community/Behavioral Health Agency
Primary
A0254001A
IL
Other
Enumeration date
02/27/2008
Last updated
04/20/2008
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