Provider Demographics
NPI:1811591373
Name:GOOD WORKS FARM, INC.
Entity Type:Organization
Organization Name:GOOD WORKS FARM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNOTAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-825-7470
Mailing Address - Street 1:1566 ROXANNA NEW BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45068-9644
Mailing Address - Country:US
Mailing Address - Phone:937-825-7470
Mailing Address - Fax:
Practice Address - Street 1:1566 ROXANNA NEW BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-9644
Practice Address - Country:US
Practice Address - Phone:937-825-7470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2904867OtherOHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES