Provider Demographics
NPI:1922270305
Name:GOODWILL INDUSTRIES OF ORANGE COUNTY, CALIFORNIA
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF ORANGE COUNTY, CALIFORNIA
Other - Org Name:ASSISTIVE TECHNOLOGY EXCHANGE CENTER (ATEC)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:TALARICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-547-6301
Mailing Address - Street 1:1601 E SAINT ANDREW PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4932
Mailing Address - Country:US
Mailing Address - Phone:714-361-6200
Mailing Address - Fax:714-361-6220
Practice Address - Street 1:1601 E SAINT ANDREW PL
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4932
Practice Address - Country:US
Practice Address - Phone:714-361-6200
Practice Address - Fax:714-361-6220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOODWILL INDUSTRIES OF ORANGE COUNTY, CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-26
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT7512225X00000X
CASP4388235Z00000X
CASP18100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty