Provider Demographics
NPI:1306027578
Name:GOODWILL INDUSTRIES OF SOUTHEASTERN WISCONSIN, INC.
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF SOUTHEASTERN WISCONSIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:STADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-358-4319
Mailing Address - Street 1:6055 N 91ST ST
Mailing Address - Street 2:P.O. BOX 250973
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-1710
Mailing Address - Country:US
Mailing Address - Phone:414-353-6400
Mailing Address - Fax:414-358-4283
Practice Address - Street 1:6055 N 91ST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-1710
Practice Address - Country:US
Practice Address - Phone:414-353-6400
Practice Address - Fax:414-358-4283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management