Provider Demographics
NPI:1346615218
Name:GOODWILL INDUSTRIES OF NORTHERN MICHIGAN
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF NORTHERN MICHIGAN
Other - Org Name:GOODWILL INN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:HOUSING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAKURA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFTERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-995-7711
Mailing Address - Street 1:2943 KEYSTONE RD N
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-8814
Mailing Address - Country:US
Mailing Address - Phone:231-922-4890
Mailing Address - Fax:
Practice Address - Street 1:2943 KEYSTONE RD N
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-8814
Practice Address - Country:US
Practice Address - Phone:231-922-4890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management