Provider Demographics
NPI:1053528687
Name:GOODWILL INDUSTRIES OF THE SOUTHERN PIEDMONT INC
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF THE SOUTHERN PIEDMONT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICIER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-372-3434
Mailing Address - Street 1:PO BOX 668768
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28266-8768
Mailing Address - Country:US
Mailing Address - Phone:704-372-3434
Mailing Address - Fax:704-972-9841
Practice Address - Street 1:2122 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5154
Practice Address - Country:US
Practice Address - Phone:704-372-3434
Practice Address - Fax:704-972-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 060 016251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services