Provider Demographics
NPI:1194334680
Name:GOODWILL CARING HEALTHCARE SERVICES
Entity type:Organization
Organization Name:GOODWILL CARING HEALTHCARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:DORA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:732-325-1683
Mailing Address - Street 1:2 CLERICO LN
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1620
Mailing Address - Country:US
Mailing Address - Phone:732-325-1683
Mailing Address - Fax:
Practice Address - Street 1:2 CLERICO LN
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1620
Practice Address - Country:US
Practice Address - Phone:732-325-1583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOODWILL CARING HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-30
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0721441Medicaid