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