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General NPI Number Information
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NPI Number | 1134276967
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Entity Type | Organization
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Legal Business Name | GOODWILL INDUSTRIES OF MICHIANA, INC.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1805 W WESTERN AVE
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City | SOUTH BEND
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State | IN
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Zip | 46619-3519
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Country | US
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Telephone | 574-472-7300
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Fax | 574-472-7302
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Provider Business Mailing Address
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Address Line | 1805 W WESTERN AVE PO BOX 3846
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City | SOUTH BEND
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State | IN
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Zip | 46619-3519
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Country | US
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Telephone | 574-472-7300
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Fax | 574-472-7302
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | J LARRY NEFF
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Credential |
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Telephone | 574-472-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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