Provider Demographics
NPI:1134276967
Name:GOODWILL INDUSTRIES OF MICHIANA, INC.
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF MICHIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:NEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-472-7300
Mailing Address - Street 1:1805 W WESTERN AVE
Mailing Address - Street 2:PO BOX 3846
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46619-3519
Mailing Address - Country:US
Mailing Address - Phone:574-472-7300
Mailing Address - Fax:574-472-7302
Practice Address - Street 1:1805 W WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-3519
Practice Address - Country:US
Practice Address - Phone:574-472-7300
Practice Address - Fax:574-472-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services