Provider Demographics
NPI:1598981730
Name:GOODWILL OF COLORADO
Entity Type:Organization
Organization Name:GOODWILL OF COLORADO
Other - Org Name:JOURNEYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-635-4483
Mailing Address - Street 1:1460 GARDEN OF THE GODS RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3414
Mailing Address - Country:US
Mailing Address - Phone:719-635-4483
Mailing Address - Fax:719-635-5713
Practice Address - Street 1:2360 MONTEBELLO SQUARE DR STE A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6901
Practice Address - Country:US
Practice Address - Phone:719-266-1202
Practice Address - Fax:719-266-6960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09489223Medicaid