COMMUNITY SUPPORT PROGRAM/REALITY HOUSE (NPI# 1972788925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972788925 |
| Entity Type | Organization |
| Organization Name | COMMUNITY SUPPORT PROGRAM/REALITY HOUSE |
| Other Organization Name | BEN GORDON CENTER |
| Practice Address |
631 S 1st St Dekalb IL 60115-4117 |
| Practice Telephone | 8157568501 |
| Practice Fax Number | 8157565849 |
| Mailing Telephone | 8157568501 |
| Mailing Fax Number | 8157565849 |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2008-10-08 |
| Authorized Official Name | MICHAEL FLORA (CEO/PRESIDENT) |
| Authorized Official Telephone | 8157564875 |
| Is Organization Subpart | Y |
| Parent Organization Name | BEN GORDON CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
A0254001A | IL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Ben Gordon Center | Other Name - Individual/Organization |
| Street Address |
631 S 1ST ST |
| City | DEKALB |
| State | IL |
| Zip Code | 60115-4117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164023719 | Amanda Marie Reeves | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2020-11-02 |
| 1184223141 | Kendra Scrutchens | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2020-10-21 |
| 1073137519 | Emily Nicole Taylor | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2020-06-01 |
| 1871117564 | Dawn Magnuson | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2020-05-29 |
| 1376164822 | Jasmine Alexis Sronkoski | Social Worker | 631 S 1st St, Dekalb, IL 60115-4117 | 2020-05-06 |
| 1831738616 | Alissa E Taylor | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2019-12-27 |
| 1912546995 | Melissa Ybarra-robinson | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2019-12-23 |
| 1144868357 | Bethany Ann Johnson | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2019-12-18 |
| 1407401086 | Dominique Marie Smith | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2019-08-09 |
| 1912551052 | Tyler Walt | Counselor | 631 S 1st St, Dekalb, IL 60115-4117 | 2019-07-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598372179 | Megan Erhart | Counselor | 304 N. 6th Street, Dekalb, IL 60115 | 2020-09-28 |
| 1689141616 | Stephanie Klewin | Psychologist | 631 S 1st Street, Dekalb, IL 60115 | 2018-10-29 |
| 1164902219 | Kimberly Ann Hart | Counselor | 290 N. Annie Glidden Drive, Gh 416, Niu, Dekalb, IL 60115 | 2018-08-17 |
| 1497235824 | Cory David Michael Hayden | Specialist/Technologist | 175 Yordon Center (niu Athletic Training), Dekalb, IL 60115 | 2018-08-15 |
| 1154807808 | Michael John Borak | Pharmacist | 975 S Annie Glidden Road, Schnucks Market Inc, Dekalb, IL 60115 | 2018-07-16 |
| 1184125841 | Candace Schroeffel | Student in an Organized Health Care Education/Training Program | 520 Garden Rd, Dekalb, IL 60115 | 2018-02-27 |
| 1033627583 | Hannah M Studebaker | Massage Therapist | 3266 Sycamore Road, Dekalb, IL 60115 | 2018-01-18 |
| 1649700238 | Jennifer Mangino | Behavioral Analyst | 138 Berkshire Dr, Dekalb, IL 60115 | 2017-06-15 |
| 1003346628 | Victoria Tullock | Counselor | 631 South First St., Dekalb, IL 60115 | 2017-06-15 |
| 1194263848 | Brianna Kraft | Specialist/Technologist | 900 Crane Dr, Dekalb, IL 60115 | 2017-02-02 |
| Find all providers in zip 60115 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528556669 | Associaiton for Individual Development | Clinic/Center | 304 N 6th St Ste C, Dekalb, IL 60115-3484 | 2018-04-24 |
| 1750327003 | Ben Gordon Center | Clinic/Center | 12 Health Services Drive, Dekalb, IL 60115 | 2006-06-22 |
| 1184154007 | Family Service Agency of Dekalb County, Inc. | Clinic/Center | 14 Health Services Dr, Dekalb, IL 60115-9637 | 2017-06-13 |
| 1306203856 | Dekalb Behavioral Health Foundation, Inc. | Clinic/Center | 631 S 1st St, Dekalb, IL 60115 | 2016-01-27 |
| 1255703450 | Dekalb Behavioral Health Foundation, Inc. | Clinic/Center | 12 Health Services Dr, Dekalb, IL 60115 | 2015-10-27 |
| 1700037512 | Ben Gordon Center | Clinic/Center | 12 Health Services Dr, Dekalb, IL 60115-9637 | 2008-10-10 |
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| 1457959256 | Association for Individual Development | Clinic/Center | 708 N Bridge St, Yorkville, IL 60560-1105 | 2020-10-14 |
| 1285231555 | Association for Individual Development | Clinic/Center | 236 W Crystal Lake Ave, Crystal Lake, IL 60014-5847 | 2020-10-08 |
| 1386241123 | Envision Unlimited | Clinic/Center | 1801 N Spaulding Ave, Chicago, IL 60647-4926 | 2020-10-05 |
| 1881291789 | Jessica Weisbach, LLC | Clinic/Center | 2257 N Kedzie Blvd Apt 3, Chicago, IL 60647-2561 | 2020-10-04 |
| 1619574803 | Envision Unlimited | Clinic/Center | 2124 W 82nd Pl, Chicago, IL 60620-5358 | 2020-10-01 |
| 1144827320 | Envision Unlimited | Clinic/Center | 4919 N Clark St, Chicago, IL 60640-3514 | 2020-10-01 |
| 1194322370 | Envision Unlimited | Clinic/Center | 4911 S Hoyne Ave, Chicago, IL 60609-4721 | 2020-10-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.