Provider Demographics
NPI:1518360775
Name:GOODWILL INDUSTRIES OF THE VALLEYS
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF THE VALLEYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-581-0620
Mailing Address - Street 1:2502 MELROSE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-3910
Mailing Address - Country:US
Mailing Address - Phone:540-581-0620
Mailing Address - Fax:540-581-0628
Practice Address - Street 1:1106 GREENVILLE AVE STE C
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-5075
Practice Address - Country:US
Practice Address - Phone:540-581-0620
Practice Address - Fax:540-581-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA240251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services