Provider Demographics
NPI:1114248861
Name:GOODWILL INDUSTRIES OF KYOWVA AREA, INC. FAMILY SERVICE DIVISION
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF KYOWVA AREA, INC. FAMILY SERVICE DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-523-9454
Mailing Address - Street 1:1102 MEMORIAL BLVD. W.
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-523-9545
Mailing Address - Fax:304-525-7038
Practice Address - Street 1:1102 MEMORIAL BLVD. W
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-523-9545
Practice Address - Fax:304-525-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health