Provider Demographics
NPI:1356721526
Name:GOLDIE B. FLOBERG CENTER FOR CHILDREN
Entity type:Organization
Organization Name:GOLDIE B. FLOBERG CENTER FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/BCBA
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PINGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:815-624-8431
Mailing Address - Street 1:58 W ROCKTON RD
Mailing Address - Street 2:
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-15-02102320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities