Provider Demographics
NPI:1720649122
Name:GOODWILL OF COLORADO
Entity Type:Organization
Organization Name:GOODWILL OF COLORADO
Other - Org Name:GOODWILL INDUSTRIES OF DENVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF COMMUNITY PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-635-4483
Mailing Address - Street 1:6850 FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-2628
Mailing Address - Country:US
Mailing Address - Phone:303-650-7700
Mailing Address - Fax:
Practice Address - Street 1:6850 FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2628
Practice Address - Country:US
Practice Address - Phone:303-650-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000143529Medicaid