Provider Demographics
NPI:1871617175
Name:GOODWILL INDUSTRIES OF THE INLAND NORTHWEST
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF THE INLAND NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/EXECUTIVE OFFICE
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:MONTGOMERY
Authorized Official - Last Name:BREKKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-444-4381
Mailing Address - Street 1:130 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1410
Mailing Address - Country:US
Mailing Address - Phone:509-838-4246
Mailing Address - Fax:509-444-4371
Practice Address - Street 1:130 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1410
Practice Address - Country:US
Practice Address - Phone:509-838-4246
Practice Address - Fax:509-444-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805073000Medicaid
ID003122600Medicaid
ID804182600Medicaid
ID807090100Medicaid
ID807365200Medicaid
ID003122500Medicaid