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General NPI Number Information
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NPI Number | 1679698195
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Entity Type | Organization
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Legal Business Name | GOODWILL INDUSTRIES NWNC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 413 THORNBURG DR SE
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City | CONOVER
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State | NC
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Zip | 28613-8845
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Country | US
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Telephone | 828-465-0371
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Fax |
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Provider Business Mailing Address
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Address Line | 413 THORNBURG DR SE
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City | CONOVER
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State | NC
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Zip | 28613-8845
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Country | US
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Telephone | 828-465-0371
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Fax |
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Authorized Official
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Title or Position | HICKORY DISTRICT DIRECTOR
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Name | MR. MALLA TONGCHY VUE
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Credential |
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Telephone | 828-465-0371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MHL-018-075
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License Number State | NC
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Taxonomy #2
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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 | MHL-018-075
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License Number State | NC
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