Provider Demographics
NPI:1285213363
Name:GOODKNIGHT THE CLUBHOUSE INC.
Entity Type:Organization
Organization Name:GOODKNIGHT THE CLUBHOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:484-769-3028
Mailing Address - Street 1:996 BAYWOOD AVE.
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565
Mailing Address - Country:US
Mailing Address - Phone:484-769-3028
Mailing Address - Fax:
Practice Address - Street 1:645 WALNUT ST.
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601
Practice Address - Country:US
Practice Address - Phone:484-755-5980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility