Provider Demographics
NPI:1922336528
Name:GOODWILL INDUSTRIES OF THE CHESAPEAKE, INC
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF THE CHESAPEAKE, INC
Other - Org Name:STEP DIVISION
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:CPRP
Authorized Official - Phone:410-625-1877
Mailing Address - Street 1:257 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5523
Mailing Address - Country:US
Mailing Address - Phone:410-875-3368
Mailing Address - Fax:
Practice Address - Street 1:257 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5523
Practice Address - Country:US
Practice Address - Phone:410-875-3368
Practice Address - Fax:410-875-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408858101Medicaid
MD418520002Medicaid