Provider Demographics
NPI:1215080783
Name:GOODWILL INDUSTRIES OF GREATER GRAND RAPIDS
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF GREATER GRAND RAPIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEOPRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-532-4200
Mailing Address - Street 1:3035 PRAIRIE ST SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2000
Mailing Address - Country:US
Mailing Address - Phone:616-532-4200
Mailing Address - Fax:616-532-3044
Practice Address - Street 1:3035 PRAIRIE ST SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2000
Practice Address - Country:US
Practice Address - Phone:616-532-4200
Practice Address - Fax:616-532-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health