1366137531 NPI number — GOODWILL INDUSTRIES OF ERIE, HURON, OTTAWA & SANDUSKY COUNTIES, INC.

Table of content: (NPI 1366137531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366137531 NPI number — GOODWILL INDUSTRIES OF ERIE, HURON, OTTAWA & SANDUSKY COUNTIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOODWILL INDUSTRIES OF ERIE, HURON, OTTAWA & SANDUSKY COUNTIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1366137531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 W MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDUSKY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44870-2411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-625-4744
Provider Business Mailing Address Fax Number:
419-625-4692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
419 W MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDUSKY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44870-2411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-625-4744
Provider Business Practice Location Address Fax Number:
419-625-4692
Provider Enumeration Date:
04/05/2023

Additional Information

Authorized Official

Authorized Official Last Name:
ROCK
Authorized Official First Name:
MARLIS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DIRECTOR OF MISSION SERVICES
Authorized Official Telephone Number:
419-625-4744

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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