Provider Demographics
NPI:1043448921
Name:GOODWILL INDUSTRIES OF WYOMING INC.
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF WYOMING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CONINE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:307-634-0823
Mailing Address - Street 1:612 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4343
Mailing Address - Country:US
Mailing Address - Phone:307-634-0823
Mailing Address - Fax:
Practice Address - Street 1:612 W 17TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4343
Practice Address - Country:US
Practice Address - Phone:307-634-0823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services