Provider Demographics
NPI:1053907964
Name:GOODWILL INDUSTRIES OF DELAWARE & DELAWARE COUNTY INC
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES OF DELAWARE & DELAWARE COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WORKFORCE INITIATIVES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROSIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-504-5737
Mailing Address - Street 1:300 E LEA BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2354
Mailing Address - Country:US
Mailing Address - Phone:302-504-5737
Mailing Address - Fax:
Practice Address - Street 1:300 E LEA BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2354
Practice Address - Country:US
Practice Address - Phone:302-761-4640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000000496Medicaid
DE221000496Medicaid