Provider Demographics
NPI:1225308760
Name:GOODWILL INDUSTRIES OF THE COASTAL EMPIRE, INC.
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF THE COASTAL EMPIRE, INC.
Other - Org Name:ADVANCE ACQUIRED BRAIN INJURY REHABILITATION PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:BARDWELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-6611
Mailing Address - Street 1:PO BOX 15007
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1707
Mailing Address - Country:US
Mailing Address - Phone:912-354-6611
Mailing Address - Fax:912-354-3787
Practice Address - Street 1:7220 SALLIE MOOD DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3921
Practice Address - Country:US
Practice Address - Phone:912-354-6611
Practice Address - Fax:912-354-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable