Provider Demographics
NPI:1760548440
Name:GOODWILL INDUSTRIES OF NE IOWA INC
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF NE IOWA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-234-4626
Mailing Address - Street 1:2640 FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5722
Mailing Address - Country:US
Mailing Address - Phone:319-234-4626
Mailing Address - Fax:319-234-2504
Practice Address - Street 1:2640 FALLS AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5722
Practice Address - Country:US
Practice Address - Phone:319-234-4626
Practice Address - Fax:319-234-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0234286Medicaid
IA0741801Medicaid
IA0741801Medicaid