Provider Demographics
NPI:1174663512
Name:MORGAN MEMORIAL GOODWILL INDUSTRIES
Entity Type:Organization
Organization Name:MORGAN MEMORIAL GOODWILL INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-541-1287
Mailing Address - Street 1:1010 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-2540
Practice Address - Country:US
Practice Address - Phone:617-541-1294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1302795Medicaid
MA1302787Medicaid