Provider Demographics
NPI:1629112966
Name:GOLDIE B. FLOBERG CENTER
Entity Type:Organization
Organization Name:GOLDIE B. FLOBERG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:815-624-8431
Mailing Address - Street 1:58 W ROCKTON RD
Mailing Address - Street 2:P.O. BOX 346
Mailing Address - City:ROCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61072-1631
Mailing Address - Country:US
Mailing Address - Phone:815-624-8431
Mailing Address - Fax:815-624-8461
Practice Address - Street 1:58 W ROCKTON RD
Practice Address - Street 2:
Practice Address - City:ROCKTON
Practice Address - State:IL
Practice Address - Zip Code:61072-1631
Practice Address - Country:US
Practice Address - Phone:815-624-8431
Practice Address - Fax:815-624-8461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL008086-10320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities