Provider Demographics
NPI:1770609323
Name:GOODWILL INDUSTRIES OF NORTHWEST NORTH CAROLINA
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF NORTHWEST NORTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASHEVILLE DISTRICT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:828-298-9023
Mailing Address - Street 1:1616 PATTON AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1726
Mailing Address - Country:US
Mailing Address - Phone:828-298-9023
Mailing Address - Fax:828-298-8365
Practice Address - Street 1:1616 PATTON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1726
Practice Address - Country:US
Practice Address - Phone:828-298-9023
Practice Address - Fax:828-298-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL011215251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409074Medicaid