Provider Demographics
NPI:1780802298
Name:GOODWILL INVALID COACH SERVICE
Entity type:Organization
Organization Name:GOODWILL INVALID COACH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAGWA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELNOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-661-3665
Mailing Address - Street 1:111 CHESTNUT ST
Mailing Address - Street 2:SUITE 605
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1841
Mailing Address - Country:US
Mailing Address - Phone:856-667-3565
Mailing Address - Fax:856-667-3565
Practice Address - Street 1:111 CHESTNUT ST
Practice Address - Street 2:SUITE 605
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1841
Practice Address - Country:US
Practice Address - Phone:856-667-3565
Practice Address - Fax:856-667-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ7528906343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7528906Medicaid