Provider Demographics
NPI:1922133792
Name:GOODWILL INDUSTRIES OF THE HEARTLAND
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF THE HEARTLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMERA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ERB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-337-4158
Mailing Address - Street 1:1410 S FIRST AVE
Mailing Address - Street 2:PO 1696
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-1696
Mailing Address - Country:US
Mailing Address - Phone:319-337-4158
Mailing Address - Fax:319-337-7369
Practice Address - Street 1:1410 S FIRST AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52244-1696
Practice Address - Country:US
Practice Address - Phone:319-337-4158
Practice Address - Fax:319-337-7369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1232918Medicaid
IA232918Medicaid
IA0147074Medicaid