Provider Demographics
NPI:1770703597
Name:GOOD WILL HOME ASSOCIATION
Entity type:Organization
Organization Name:GOOD WILL HOME ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:COLAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:207-238-4000
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:ME
Mailing Address - Zip Code:04944-0159
Mailing Address - Country:US
Mailing Address - Phone:207-238-4000
Mailing Address - Fax:207-238-4017
Practice Address - Street 1:WATERVILLE RD
Practice Address - Street 2:PRESCOTT ADMINISTRATION BLDG.
Practice Address - City:HINCKLEY
Practice Address - State:ME
Practice Address - Zip Code:04944-0159
Practice Address - Country:US
Practice Address - Phone:207-238-4000
Practice Address - Fax:207-238-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS885322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME101810004Medicaid
ME101810006Medicaid
ME101810103Medicaid
ME101810008Medicaid
ME101810001Medicaid
ME101810005Medicaid
ME101810002Medicaid
ME101810003Medicaid
ME101810009Medicaid
ME431543400Medicaid
ME101810000Medicaid
ME101810007Medicaid