COMMUNITY SUPPORT PROGRAM/REALITY HOUSE NPI 1972788925

NPI Information

NPI: 1972788925
Provider Name: COMMUNITY SUPPORT PROGRAM/REALITY HOUSE

Other Name: BEN GORDON CENTER

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
631 S 1ST ST
DEKALB, IL
ZIP 60115
Phone: (815) 756-8501
Get Directions

COMMUNITY SUPPORT PROGRAM/REALITY HOUSE is a mental health (including community mental health center) clinic center in Dekalb, IL. COMMUNITY SUPPORT PROGRAM/REALITY HOUSE NPI is 1972788925. The provider is registered as an organization entity type.
The provider Other Name Is Ben Gordon Center.

The provider's business location address is:

631 S 1ST ST
DEKALB, IL
ZIP 60115-117
Phone: (815) 756-8501
Fax: (815) 756-5849

The provider's authorized official is Michael Flora .
The authorized official title is Ceo/president and has the following contact phone number (815) 756-4875.

The enumeration date for this NPI number is 1/8/2008 and was last updated on 10/8/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	A0254001A	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========003	MEDICAID	ILLINOIS
2	207498	MEDICARE PIN	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »