Provider Demographics
NPI:1780912394
Name:GOODWILL INDUSTRIES OF THE CHESAPEAKE, INC
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF THE CHESAPEAKE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:CPRP
Authorized Official - Phone:410-625-1877
Mailing Address - Street 1:711 BEL AIR RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4209
Mailing Address - Country:US
Mailing Address - Phone:410-879-4010
Mailing Address - Fax:410-879-4029
Practice Address - Street 1:711 BEL AIR RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4209
Practice Address - Country:US
Practice Address - Phone:410-879-4010
Practice Address - Fax:410-879-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408858103Medicaid