Community Support Program/reality House

NPI #1972788925 in Dekalb, Illinois

Provider Information

NPI Number: 1972788925
Entity Type: Organization
Organization Name: Community Support Program/reality House
Subpart: Yes (part of a larger organization)
Parent Organization: BEN GORDON CENTER
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Jan 8, 2008
Last Updated: Oct 8, 2008

Practice Location

Address: 631 S 1ST ST
City: Dekalb
State: Illinois
ZIP Code: 60115-4117
Phone: (815) 756-8501

Authorized Official

Name: MICHAEL FLORA
Title: CEO/PRESIDENT
Phone: (815) 756-4875

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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