NPIMap

Organization Active NPI

Community Support Program/Reality House

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dekalb, IL
National Provider Identifier
1972788925
Registry record updated Oct 8, 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
COMMUNITY SUPPORT PROGRAM/REALITY HOUSE
Practice address
631 S 1St St
Dekalb, IL 60115-4117
Phone
(815) 756-8501
Fax
(815) 756-5849
NPI assigned
Jan 8, 2008
Last updated
Oct 8, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
BEN GORDON CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 8, 2008

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

Authorized official

Name
Michael FloraNPI 1124242763
Title
Ceo/President
Phone
(815) 756-4875

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

631 S 1St St
Dekalb, IL 60115-4117

Mailing address

631 S 1St St
Dekalb, IL 60115-4117
Phone (815) 756-8501

Other names 1

  • Ben Gordon Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Ben Gordon Center8 organizations share this tax ID, including this one
Part of
Ben Gordon Center

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223424000000",
    "number": "1972788925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 S 1ST ST",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601154117",
            "telephone_number": "815-756-8501",
            "fax_number": "815-756-5849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 S 1ST ST",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601154117",
            "telephone_number": "815-756-8501",
            "fax_number": "815-756-5849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY SUPPORT PROGRAM/REALITY HOUSE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEN GORDON CENTER",
        "enumeration_date": "2008-01-08",
        "last_updated": "2008-10-08",
        "status": "A",
        "authorized_official_last_name": "FLORA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "815-756-4875"
    },
    "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": "Ben Gordon Center",
            "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 8, 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.