Provider Demographics
NPI:1861614133
Name:GOODWILL INDUSTRIES OF RHODE ISLAND
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF RHODE ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-861-2080
Mailing Address - Street 1:100 HOUGHTON STREET
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1013
Mailing Address - Country:US
Mailing Address - Phone:401-861-2080
Mailing Address - Fax:401-454-0889
Practice Address - Street 1:100 HOUGHTON STREET
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1013
Practice Address - Country:US
Practice Address - Phone:401-861-2080
Practice Address - Fax:401-454-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGI32135Medicaid