Provider Demographics
NPI:1467927145
Name:GOODWILL INDUSTRIES OF NORTHERN WISCONSIN AND UPPER MICHIGAN INC.
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF NORTHERN WISCONSIN AND UPPER MICHIGAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR, WORKFORCE DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-273-1830
Mailing Address - Street 1:201 RUBLEIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4060
Mailing Address - Country:US
Mailing Address - Phone:906-273-1830
Mailing Address - Fax:
Practice Address - Street 1:1805 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-3339
Practice Address - Country:US
Practice Address - Phone:715-732-0563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities