Provider Demographics
NPI:1245457035
Name:GOODWILL OF COLORADO
Entity type:Organization
Organization Name:GOODWILL OF COLORADO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-635-4483
Mailing Address - Street 1:1460 GARDEN OF THE GODS RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3414
Mailing Address - Country:US
Mailing Address - Phone:719-635-4483
Mailing Address - Fax:719-635-5713
Practice Address - Street 1:1460 GARDEN OF THE GODS RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-635-4483
Practice Address - Fax:719-635-5713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X, 376J00000X, 385H00000X, 251C00000X, 261QA0600X, 343900000X, 251E00000X
CO1005UO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1005UOOtherCLASS B LICENSE
CO90129377Medicaid
CO04A845OtherCLASS A LICENSE
CO067533Medicare UPIN
CO90129377Medicaid
CO90129377Medicare Oscar/Certification