MEDICARE: GOODWILL INDUSTRIES OF ARKANSAS, INC

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	251300000X	Local Education Agency (LEA)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699987826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODWILL INDUSTRIES OF ARKANSAS, INC

Provider Business Mailing Address
First Line	:	1110 W 7TH ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-3909
Country	:	US
Telephone Number	:	501-372-5100
Fax Number	:	501-372-5112

Provider Business Practice Location Address
First Line	:	1110 W 7TH ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-3909
Country	:	US
Telephone Number	:	501-372-5100
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF EDUCATION & TRAINING
Name	:	MRS. DALE HOFF
Credential	:
Telephone Number	:	501-372-5100

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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