BEN GORDON CENTER (NPI# 1922277631) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922277631 |
| Entity Type | Organization |
| Organization Name | BEN GORDON CENTER |
| Other Organization Name | DASA MEDICAID PROVIDER |
| Practice Address |
12 Health Services Dr Dekalb IL 60115-9637 |
| Practice Telephone | 8157564875 |
| Practice Fax Number | 8157562944 |
| Mailing Telephone | 8157564875 |
| Mailing Fax Number | 8157562944 |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | MR. 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 | 251S00000X | Community/Behavioral Health | A0254001A | IL | Agencies |
| Other Name | Type Code |
|---|---|
| DASA Medicaid Provider | Other Name - Individual/Organization |
| 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 |
| 1457654295 | Ben Gordon Center | Clinic/Center | 21193 Malta Rd, Bldg. A - U154, Malta, IL 60150-9600 | 2010-12-17 |
| 1700037512 | Ben Gordon Center | Clinic/Center | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2008-10-10 |
| 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 |
12 HEALTH SERVICES DR |
| City | DEKALB |
| State | IL |
| Zip Code | 60115-9637 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144393497 | Amylynn M Weiten | Counselor | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2006-11-16 |
| 1952900375 | Brianna Rae Johnson | Counselor | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-10-19 |
| 1215543111 | Rhyann Brianna Locke | Social Worker | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-09-17 |
| 1952925182 | Mariah Anne Thompson | Counselor | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-06-03 |
| 1376167734 | Hannah Grace Brennan | Counselor | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-06-02 |
| 1619590981 | Samantha Nikole Gudmunson | Registered Nurse | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-05-21 |
| 1992326151 | Dianna Huttunen | Case Management | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-04-29 |
| 1558982702 | Kathleen C Wilkerson | Case Management | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-04-29 |
| 1457983108 | Andrew Ryan Phillips | Counselor | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2020-02-11 |
| 1225670219 | Bonn Christian Cruz | Counselor | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2019-10-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598372179 | Megan Erhart | Counselor | 304 N. 6th Street, Dekalb, IL 60115 | 2020-09-28 |
| 1689141616 | Stephanie Klewin | Psychologist | 631 S 1st Street, Dekalb, IL 60115 | 2018-10-29 |
| 1164902219 | Kimberly Ann Hart | Counselor | 290 N. Annie Glidden Drive, Gh 416, Niu, Dekalb, IL 60115 | 2018-08-17 |
| 1497235824 | Cory David Michael Hayden | Specialist/Technologist | 175 Yordon Center (niu Athletic Training), Dekalb, IL 60115 | 2018-08-15 |
| 1154807808 | Michael John Borak | Pharmacist | 975 S Annie Glidden Road, Schnucks Market Inc, Dekalb, IL 60115 | 2018-07-16 |
| 1184125841 | Candace Schroeffel | Student in an Organized Health Care Education/Training Program | 520 Garden Rd, Dekalb, IL 60115 | 2018-02-27 |
| 1033627583 | Hannah M Studebaker | Massage Therapist | 3266 Sycamore Road, Dekalb, IL 60115 | 2018-01-18 |
| 1649700238 | Jennifer Mangino | Behavioral Analyst | 138 Berkshire Dr, Dekalb, IL 60115 | 2017-06-15 |
| 1003346628 | Victoria Tullock | Counselor | 631 South First St., Dekalb, IL 60115 | 2017-06-15 |
| 1194263848 | Brianna Kraft | Specialist/Technologist | 900 Crane Dr, Dekalb, IL 60115 | 2017-02-02 |
| Find all providers in zip 60115 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124488945 | Association for Individual Development | Community/Behavioral Health | 507 E Taylor St, Dekalb, IL 60115-4573 | 2016-03-07 |
| 1205388147 | Comprehensive Rehabilitation Services, Inc | Community/Behavioral Health | 2500 N Annie Glidden Rd, Suite F, Dekalb, IL 60115-1310 | 2016-10-26 |
| 1518357995 | The Ben Gordon Center | Community/Behavioral Health | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2015-01-23 |
| 1922370527 | Parents With Promise LLC | Community/Behavioral Health | 810 S 4th St, Dekalb, IL 60115-4410 | 2012-01-30 |
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|---|---|---|---|---|
| 1144820648 | Community Wellness Group | Community/Behavioral Health | 635 Argyle Ave, Flossmoor, IL 60422-1201 | 2020-10-26 |
| 1437758711 | Gina Baldacci, Lcsw, LLC | Community/Behavioral Health | 231 Longridge Dr, Bloomingdale, IL 60108 | 2020-10-19 |
| 1790383610 | Joni Lamb Therapy, LLC | Community/Behavioral Health | 1555 Sherman Ave # 308, Evanston, IL 60201-4421 | 2020-10-13 |
| 1811594906 | Everyday Empowered Clinical Services, Ltd. | Community/Behavioral Health | 5117 Main St, Suite #7, Downers Grove, IL 60515 | 2020-10-02 |
| 1942817150 | Pacem Wellness, LLC | Community/Behavioral Health | 8 Eagle Ctr Ste 12, O Fallon, IL 62269-1947 | 2020-09-30 |
| 1831703271 | Boules Clinical Psychology Group | Community/Behavioral Health | 200 S Frontage Rd Ste 324, Burr Ridge, IL 60527-6953 | 2020-09-02 |
| 1336753896 | Counseling Kennedy Shenberg | Community/Behavioral Health | 5752 N Campbell Ave Apt 1, Chicago, IL 60659-5080 | 2020-09-02 |
| 1265045371 | Brightside Recovery | Community/Behavioral Health | 1667 Belvidere Rd, Belvidere, IL 61008-9306 | 2020-08-28 |
| 1902419021 | Brightside Recovery | Community/Behavioral Health | 8041 186th St Ste B, Tinley Park, IL 60487-9344 | 2020-08-28 |
| 1700498573 | Bobby E. Wright Comprehensive Behavioral Health Center, Inc. | Community/Behavioral Health | 5816 W Division St Fl 1, Chicago, IL 60651-1003 | 2020-08-21 |
| 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.