Provider Demographics
NPI:1659519205
Name:GOODWILL INDUSTRIES OF WEST MICHIGAN
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF WEST MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VOCATIONAL REHABILITATIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLPC
Authorized Official - Phone:231-722-7871
Mailing Address - Street 1:271 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3408
Mailing Address - Country:US
Mailing Address - Phone:231-722-7871
Mailing Address - Fax:231-728-6408
Practice Address - Street 1:271 E. APPLE AVENUE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3408
Practice Address - Country:US
Practice Address - Phone:231-722-7871
Practice Address - Fax:231-728-6408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services