Organization
COMMUNITY SUPPORT PROGRAM/REALITY HOUSE
Active
Parent organization
BEN GORDON CENTER
Other names
Ben Gordon Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEN GORDON CENTER
Authorized official
MICHAEL FLORA (CEO/PRESIDENT)
(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
631 S 1ST ST, DEKALB, IL 60115-4117
(815) 756-8501
(815) 756-5849
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
A0254001A
IL
Other
Enumeration date
01/08/2008
Last updated
10/08/2008
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