Provider Demographics
NPI:1255899076
Name:GOODWILL VENTURES INC
Entity type:Organization
Organization Name:GOODWILL VENTURES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ROSVI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-358-9917
Mailing Address - Street 1:6149 GLENBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-6017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 ANTIGUA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6142
Practice Address - Country:US
Practice Address - Phone:702-358-9917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5432-AGC-8Medicaid