Provider Demographics
NPI:1548358245
Name:GOODWILL INDUSTRIES OF GREATER DETROIT
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF GREATER DETROIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:UTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-557-8787
Mailing Address - Street 1:3111 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2962
Mailing Address - Country:US
Mailing Address - Phone:313-964-3900
Mailing Address - Fax:313-964-3909
Practice Address - Street 1:3111 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2962
Practice Address - Country:US
Practice Address - Phone:313-964-3900
Practice Address - Fax:313-964-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2783305Medicaid