BEN GORDON CENTER (NPI# 1457654295) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457654295 |
| Entity Type | Organization |
| Organization Name | BEN GORDON CENTER |
| Practice Address |
21193 Malta Rd Bldg. A - U154 Malta IL 60150-9600 |
| Practice Telephone | 8157564875 |
| Practice Fax Number | 8157562944 |
| Mailing Telephone | 8157564875 |
| Mailing Fax Number | 8157562944 |
| Enumeration Date | 2010-12-17 |
| Last Update Date | 2010-12-17 |
| Authorized Official Name | MICHAEL FLORA (CEO/PRESIDENT) |
| Authorized Official Telephone | 8157564875 |
| Is Organization Subpart | Y |
| Parent Organization Name | BEN GORDON CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
A0254001A | IL | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750327003 | Ben Gordon Center | Clinic/Center | 12 Health Services Drive, Dekalb, IL 60115 | 2006-06-22 |
| 1164802922 | Ben Gordon Center | Preferred Provider Organization | 631 S 1st St, Dekalb, IL 60115-4117 | 2015-06-05 |
| 1164847430 | Ben Gordon Center | Counselor | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2014-02-24 |
| 1700037512 | Ben Gordon Center | Clinic/Center | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2008-10-10 |
| 1922277631 | Ben Gordon Center | Community/Behavioral Health | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2008-02-27 |
| 1598940546 | Ben Gordon Center | Clinic/Center | 100 S Latham St, Suite 204, Sandwich, IL 60548-2276 | 2008-01-08 |
| 1962687913 | Ben Gordon Center | Clinic/Center | 599 Pearson Dr, Genoa, IL 60135-1355 | 2008-01-08 |
| Street Address |
21193 MALTA RD BLDG. A - U154 |
| City | MALTA |
| State | IL |
| Zip Code | 60150-9600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376517722 | Michele L Roberts | Physician Assistant | 21193 Malta Rd, Malta, IL 60150-9600 | 2006-02-14 |
| 1760729925 | Center for Family Health - Malta | Clinic/Center | 21193 Malta Rd, Malta, IL 60150-9600 | 2013-01-08 |
| 1225218365 | Northern Illinois University | Clinic/Center | 21193 Malta Rd, Malta, IL 60150-9600 | 2007-11-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063791218 | Malta Family Dental LLC | Dental Hygienist | 304 Van Buren St, Malta, IL 60150-9512 | 2011-08-05 |
| 1275068660 | Marissa Nicole Maeder | Specialist/Technologist, Other | 205 S 6th St, Malta, IL 60150-9703 | 2017-04-24 |
| 1922351386 | Malta Fire Protection District | Ambulance | 308 Jefferson St, Malta, IL 60150-9738 | 2012-10-23 |
| 1558509208 | Jill Reiland | Occupational Therapist | 510 N 3rd St, Malta, IL 60150-9771 | 2009-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912507328 | Cassandra Coppola | Physical Therapy Assistant | 2202 Concord St, Malta, NY 12020-5265 | 2020-10-27 |
| 1215553839 | Eloise Porte Parker | Psychologist | 92 Lakeshore Dr, Malta, NY 12020-6240 | 2020-06-19 |
| 1225650849 | Mark Nistico | Registered Nurse | 23 Mayapple Way, Malta, NY 12020-4390 | 2020-05-18 |
| 1831710979 | Elizabeth Jean Simpson | Physical Therapy Assistant | 801s 3rd St., Malta, MT 59538 | 2020-04-29 |
| 1811529415 | Peter Joseph Valastro Jr. | Registered Nurse | 2452 Us Rt 9 Suite 206, Malta, NY 12020 | 2020-02-11 |
| 1114561859 | Rad Bintareef | Ophthalmology | 658 Malta Ave Ste 101, Malta, NY 12020-4105 | 2019-11-06 |
| 1073077020 | Kaleb Wilkins | Registered Nurse | 859 South Main St., Malta, OH 43758 | 2019-01-24 |
| 1336613199 | Tyson Copenhaver Carney | Specialist/Technologist | 631 S 6th Ave E, Malta, MT 59538-8893 | 2019-01-15 |
| 1700356300 | Melissa Lynn Jones | Registered Nurse | 545 N Riverview Rd, Malta, OH 43758-9301 | 2018-11-27 |
| 1922583186 | Tiffany Marie Mcgrew | Licensed Practical Nurse | 3664 Finley Lane, Malta, OH 43758 | 2018-10-03 |
| Find all providers in MALTA | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.