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General NPI Number Information
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NPI Number | 1720360357
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Entity Type | Organization
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Legal Business Name | GOODWILL INDUSTRIES NA
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 2670 HIGHWAY 95
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-7744
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Country | US
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Telephone | 928-704-7780
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Fax |
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Provider Business Mailing Address
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Address Line | 2225 N STEVES BLVD
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City | FLAGSTAFF
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State | AZ
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Zip | 86001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF HR
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Name | JORDAN HOFFMAN
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Credential |
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Telephone | 928-526-9188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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