NPI 1164802922

Ben Gordon Center

Organisation Preferred Provider Organization Dekalb, IL

Practice location

Address: 631 S 1st St, Dekalb, IL 60115-4117
Phone: (815) 756-8501
Fax: (815) 756-5849
Mailing address: 12 Health Services Dr, Dekalb, IL 60115-9637

Authorised official

Name: Bettyjo Bieberitz
Title: Contract Coordinator
Phone: (815) 756-4875

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 149017667 (IL)

Other Preferred Provider Organization providers in Illinois →

Registry record

NPI: 1164802922
Entity type: Organization
NPI issued: 5 Jun 2015
Record last updated: 14 Jul 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.