Provider Demographics
NPI:1013450097
Name:GOOD WILL HOME ASSOCIATION
Entity Type:Organization
Organization Name:GOOD WILL HOME ASSOCIATION
Other - Org Name:GOOD WILL-HINCKLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERENC-MCGORTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-238-4000
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:16 PRESCOTT DRIVE
Mailing Address - City:HINCKLEY
Mailing Address - State:ME
Mailing Address - Zip Code:04944-0159
Mailing Address - Country:US
Mailing Address - Phone:207-238-4000
Mailing Address - Fax:207-238-4017
Practice Address - Street 1:16 PRESCOTT DRIVE
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:ME
Practice Address - Zip Code:04944-0159
Practice Address - Country:US
Practice Address - Phone:207-238-4000
Practice Address - Fax:207-238-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME414770251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health