Provider Demographics
NPI:1972511871
Name:GOOD WILL INSTITUTE FOR HEALTH SERVICES INC
Entity Type:Organization
Organization Name:GOOD WILL INSTITUTE FOR HEALTH SERVICES INC
Other - Org Name:GOOD WILL INSTITUTE FOR HEALTH SERVICES INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, NP-C
Authorized Official - Phone:504-606-6075
Mailing Address - Street 1:304 W HONORS POINT CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5774
Mailing Address - Country:US
Mailing Address - Phone:504-606-6075
Mailing Address - Fax:985-781-8065
Practice Address - Street 1:304 W HONORS POINT CT
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5774
Practice Address - Country:US
Practice Address - Phone:504-606-6075
Practice Address - Fax:985-781-8065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1581046Medicaid
LA1581046Medicaid