Provider Demographics
NPI:1184836090
Name:GOODWILL INDUSTRIES OF CENTRAL INDIANA, INC.
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF CENTRAL INDIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF WORKFORCE SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-524-4204
Mailing Address - Street 1:1635 W MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-4389
Mailing Address - Country:US
Mailing Address - Phone:317-524-4313
Mailing Address - Fax:
Practice Address - Street 1:707 E STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1756
Practice Address - Country:US
Practice Address - Phone:317-398-6183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services