Provider Demographics
NPI:1619291838
Name:GOODWILL EASTER SEALS MIAMI VALLEY
Entity Type:Organization
Organization Name:GOODWILL EASTER SEALS MIAMI VALLEY
Other - Org Name:GOODWILL INDUSTRIES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:TUSCHONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-461-4800
Mailing Address - Street 1:660 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2708
Mailing Address - Country:US
Mailing Address - Phone:937-461-4800
Mailing Address - Fax:937-461-9578
Practice Address - Street 1:660 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2708
Practice Address - Country:US
Practice Address - Phone:937-461-4800
Practice Address - Fax:937-461-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2284504Medicaid