Provider Demographics
NPI:1083814388
Name:GOODWILL INDUSTRIES OF KANAWHA VALLEY
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF KANAWHA VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. EMPLOYMENT, EDUCATION & TRAIN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-346-0811
Mailing Address - Street 1:215 VIRGINIA ST W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-2210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 VIRGINIA ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2210
Practice Address - Country:US
Practice Address - Phone:304-346-0811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty