Healthcare Provider Details

I. General information

NPI: 1598981730
Provider Name (Legal Business Name): GOODWILL OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 MONTEBELLO SQUARE DR STE A
COLORADO SPRINGS CO
80918-6901
US

IV. Provider business mailing address

1460 GARDEN OF THE GODS RD
COLORADO SPRINGS CO
80907-3414
US

V. Phone/Fax

Practice location:
  • Phone: 719-266-1202
  • Fax: 719-266-6960
Mailing address:
  • Phone: 719-635-4483
  • Fax: 719-635-5713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. KARLA GRAZIER
Title or Position: CEO
Credential:
Phone: 719-635-4483