Provider Demographics
NPI:1699987826
Name:GOODWILL INDUSTRIES OF ARKANSAS, INC
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF ARKANSAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF EDUCATION & TRAINING
Authorized Official - Prefix:MRS
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-372-5100
Mailing Address - Street 1:1110 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-3909
Mailing Address - Country:US
Mailing Address - Phone:501-372-5100
Mailing Address - Fax:501-372-5112
Practice Address - Street 1:1110 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-3909
Practice Address - Country:US
Practice Address - Phone:501-372-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR16072412560Medicaid