Provider Demographics
NPI:1588785463
Name:GOODWILL INDUSTRIES OF NORTHERN NEW ENGLAND
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF NORTHERN NEW ENGLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR, CLINICAL SVC
Authorized Official - Prefix:
Authorized Official - First Name:SHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CBIST, LSX
Authorized Official - Phone:207-795-6110
Mailing Address - Street 1:75 WASHINGTON AVENUE
Mailing Address - Street 2:SUIT 300
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101
Mailing Address - Country:US
Mailing Address - Phone:207-774-6323
Mailing Address - Fax:207-761-8460
Practice Address - Street 1:75 WASHINGTON AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-774-6323
Practice Address - Fax:207-761-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME104490002Medicaid
ME104490100Medicaid
ME104490300Medicaid
ME104490303Medicaid
ME104490000Medicaid
ME104490200Medicaid
ME104490001Medicaid
ME104490301Medicaid
ME104490201Medicaid
ME104490302Medicaid
ME104490300Medicaid
ME104490302Medicaid
ME104490303Medicaid
ME104490201Medicaid
ME104490200Medicaid
MEGOME1025Medicare ID - Type UnspecifiedBAYSIDE PT