Provider Demographics
NPI:1861699480
Name:GOODWILL INDUSTRIES OF ST CLAIR COUNTY
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF ST CLAIR COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PAPES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:810-987-9333
Mailing Address - Street 1:1013 26TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-4853
Mailing Address - Country:US
Mailing Address - Phone:810-987-9333
Mailing Address - Fax:810-987-3121
Practice Address - Street 1:1013 26TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-4853
Practice Address - Country:US
Practice Address - Phone:810-987-9333
Practice Address - Fax:810-987-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services