Provider Demographics
NPI:1043755093
Name:GOODWILL HEALTHCARE INC
Entity Type:Organization
Organization Name:GOODWILL HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:ONUOHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-531-8036
Mailing Address - Street 1:216 PIN OAK RD
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-8330
Mailing Address - Country:US
Mailing Address - Phone:908-531-8036
Mailing Address - Fax:
Practice Address - Street 1:18 N 7TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2110
Practice Address - Country:US
Practice Address - Phone:570-664-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA32113601251E00000X
253Z00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103354757Medicaid