Provider Demographics
NPI:1336349828
Name:GOODWILL INDUSTRIES OF THE CHESAPEAKE, INC
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF THE CHESAPEAKE, INC
Other - Org Name:STEP DIVISION OF GOODWILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF WFD
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-837-1800
Mailing Address - Street 1:1609 DRUID HILL AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3427
Mailing Address - Country:US
Mailing Address - Phone:410-837-1800
Mailing Address - Fax:410-837-8931
Practice Address - Street 1:222 E REDWOOD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3312
Practice Address - Country:US
Practice Address - Phone:410-625-1877
Practice Address - Fax:443-873-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408858100Medicaid