Provider Demographics
NPI:1063697290
Name:GOODWILL INDUSTRIES OF SOUTHEASTERN MICHIGAN, INC.
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF SOUTHEASTERN MICHIGAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPPING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-263-2135
Mailing Address - Street 1:600 E BEECHER ST
Mailing Address - Street 2:P.O. BOX 805
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-3907
Mailing Address - Country:US
Mailing Address - Phone:517-263-2135
Mailing Address - Fax:517-265-9740
Practice Address - Street 1:600 E BEECHER ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-3907
Practice Address - Country:US
Practice Address - Phone:517-263-2135
Practice Address - Fax:517-265-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health