Provider Demographics
NPI:1336620889
Name:GOODWILL INDUSTRIES OF SOUTH TEXAS
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF SOUTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF MISSION SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:LOERA
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER'S DEGREE
Authorized Official - Phone:361-884-4068
Mailing Address - Street 1:2961 S PORT AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-2098
Mailing Address - Country:US
Mailing Address - Phone:361-884-4068
Mailing Address - Fax:361-884-4090
Practice Address - Street 1:2961 S PORT AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-2098
Practice Address - Country:US
Practice Address - Phone:361-884-4068
Practice Address - Fax:361-884-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health