Provider Demographics
NPI:1649394354
Name:GOODWILL INDUSTRIES OF CENTRAL IA
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF CENTRAL IA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-265-5323
Mailing Address - Street 1:4900 NE 22ND ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-2518
Mailing Address - Country:US
Mailing Address - Phone:515-265-5323
Mailing Address - Fax:
Practice Address - Street 1:4900 NE 22ND ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-2518
Practice Address - Country:US
Practice Address - Phone:515-265-5323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0231118Medicaid