MEDICARE: GOODWILL INDUSTRIES OF CENTRAL INDIANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency		IN

General Provider Information

NPI Number	:	1558582098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODWILL INDUSTRIES OF CENTRAL INDIANA

Provider Business Mailing Address
First Line	:	1635 W MICHIGAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-4389
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 N TREMONT ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-3772
Country	:	US
Telephone Number	:	317-524-4343
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF WORKFORCE SERVICE
Name	:	JIM HUMPHREY
Credential	:
Telephone Number	:	317-524-4204

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	08/22/2020

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Directions to “GOODWILL INDUSTRIES OF CENTRAL INDIANA ” Practice Location

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