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General NPI Number Information
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NPI Number | 1659519205
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Entity Type | Organization
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Legal Business Name | GOODWILL INDUSTRIES OF WEST MICHIGAN
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 271 E. APPLE AVENUE
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City | MUSKEGON
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State | MI
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Zip | 49442-3408
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Country | US
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Telephone | 231-722-7871
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Fax | 231-728-6408
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Provider Business Mailing Address
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Address Line | 271 E APPLE AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-3408
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Country | US
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Telephone | 231-722-7871
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Fax | 231-728-6408
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Authorized Official
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Title or Position | VOCATIONAL REHABILITATIONAL MANAGER
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Name | STEPHANIE D. LARSON
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Credential | MA, LLPC
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Telephone | 231-722-7871
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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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