Provider Demographics
NPI:1154453546
Name:GOODWILL OF THE SOUTHERN ALLEGHENIES
Entity Type:Organization
Organization Name:GOODWILL OF THE SOUTHERN ALLEGHENIES
Other - Org Name:GOODWILL INDUSTRIES OF THE CONEMAUGH VALLEY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-254-9700
Mailing Address - Street 1:540 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15902-2674
Mailing Address - Country:US
Mailing Address - Phone:814-536-3536
Mailing Address - Fax:814-536-5171
Practice Address - Street 1:540 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15902-2674
Practice Address - Country:US
Practice Address - Phone:814-536-3536
Practice Address - Fax:814-536-5171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA306150251S00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health