Provider Demographics
NPI:1639303167
Name:GOODWILL INDUSTRIES OF WY, INC.
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF WY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-634-0823
Mailing Address - Street 1:612 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4343
Mailing Address - Country:US
Mailing Address - Phone:307-634-0823
Mailing Address - Fax:307-778-6655
Practice Address - Street 1:612 W 17TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4343
Practice Address - Country:US
Practice Address - Phone:307-634-0823
Practice Address - Fax:307-778-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management