Provider Demographics
NPI:1750751780
Name:GOODWILL INDUSTRIES OF SANTA CLARA COUNTY
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF SANTA CLARA COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF MISSION SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-869-9230
Mailing Address - Street 1:1080 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-4425
Mailing Address - Country:US
Mailing Address - Phone:408-869-9160
Mailing Address - Fax:408-869-9172
Practice Address - Street 1:1080 N 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4425
Practice Address - Country:US
Practice Address - Phone:408-869-9160
Practice Address - Fax:408-869-9172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2021-06-22
Deactivation Date:2021-05-16
Deactivation Code:
Reactivation Date:2021-06-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health