NPIMap

Organization Active NPI

Ben Gordon Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dekalb, IL
National Provider Identifier
1700037512
Registry record updated Oct 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
A0254001A Issued in IL
Legal business name
BEN GORDON CENTER
Practice address
12 Health Services Dr
Dekalb, IL 60115-9637
Phone
(815) 756-4875
Fax
(815) 756-2944
NPI assigned
Oct 10, 2008
Organization subpart
Yes
Parent organization
BEN GORDON CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 10, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Kimberly Kruppenbacher
Title
Credentialing Coordinator
Phone
(815) 756-4875

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X A0254001A IL Primary

Addresses

Primary practice location

12 Health Services Dr
Dekalb, IL 60115-9637

Mailing address

12 Health Services Dr
Dekalb, IL 60115-9637
Phone (815) 756-4875

Other names 1

  • Kid Care Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Ben Gordon CMH Center I8 organizations share this tax ID, including this one
Part of
Ben Gordon CMH Center I

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223596800000",
    "number": "1700037512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 HEALTH SERVICES DR",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159637",
            "telephone_number": "815-756-4875",
            "fax_number": "815-756-2944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 HEALTH SERVICES DR",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159637",
            "telephone_number": "815-756-4875",
            "fax_number": "815-756-2944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEN GORDON CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEN GORDON CENTER",
        "enumeration_date": "2008-10-10",
        "last_updated": "2008-10-10",
        "status": "A",
        "authorized_official_last_name": "KRUPPENBACHER",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "815-756-4875",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IL",
            "license": "A0254001A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kid Care Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dekalb, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.