Provider Demographics
NPI:1801244363
Name:LAND OF LINCOLN GOODWILL INDUSTRIES
Entity type:Organization
Organization Name:LAND OF LINCOLN GOODWILL INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF VOCATIONAL REHAB
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MABERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:217-494-7198
Mailing Address - Street 1:1220 OUTER PARK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4409
Mailing Address - Country:US
Mailing Address - Phone:217-789-0400
Mailing Address - Fax:
Practice Address - Street 1:1220 OUTER PARK DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4409
Practice Address - Country:US
Practice Address - Phone:217-789-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services