| Organization Name: | BEN GORDON CENTER |
| NPI Number: | 1962687913 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL FLORA (CEO/PRESIDENT) |
| Mailing Address: | 599 Pearson Dr Genoa |
| State: | IL US |
| Postal Code: | 601351355 |
| Phone Number: | 8157846029 |
| Fax Number: | |
| NPI Enumeration Date: | 01/08/2008 |
| NPI Last Update Date: | 10/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | A0254001A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |