Healthcare Provider Details

I. General information

NPI: 1841599669
Provider Name (Legal Business Name): GOODWILL INDUSTRIES OF GREATER DETROIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9622 GRAND RIVER AVE
DETROIT MI
48204-2138
US

IV. Provider business mailing address

3111 GRAND RIVER AVE
DETROIT MI
48208-2962
US

V. Phone/Fax

Practice location:
  • Phone: 313-931-0901
  • Fax: 313-931-0904
Mailing address:
  • Phone: 313-964-3900
  • Fax: 313-964-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORNA G UTLEY
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 313-557-8787