1588785463 NPI number — GOODWILL INDUSTRIES OF NORTHERN NEW ENGLAND

Table of content: (NPI 1588785463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588785463 NPI number — GOODWILL INDUSTRIES OF NORTHERN NEW ENGLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOODWILL INDUSTRIES OF NORTHERN NEW ENGLAND
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOODWILL OF MAINE
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588785463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 WASHINGTON AVENUE
Provider Second Line Business Mailing Address:
SUIT 300
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-774-6323
Provider Business Mailing Address Fax Number:
207-761-8460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 WASHINGTON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-774-6323
Provider Business Practice Location Address Fax Number:
207-761-8460
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
SHARLENE
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR, CLINICAL SVC
Authorized Official Telephone Number:
207-795-6110

Provider Taxonomy Codes

  • Taxonomy code: 103TP2701X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XN1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104490002 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104490100 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104490300 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104490303 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104490000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104490200 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104490001 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104490301 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104490201 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104490302 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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