Provider Demographics
NPI:1679698195
Name:GOODWILL INDUSTRIES NWNC
Entity type:Organization
Organization Name:GOODWILL INDUSTRIES NWNC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HICKORY DISTRICT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MALLA
Authorized Official - Middle Name:TONGCHY
Authorized Official - Last Name:VUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-465-0371
Mailing Address - Street 1:413 THORNBURG DR SE
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8845
Mailing Address - Country:US
Mailing Address - Phone:828-465-0371
Mailing Address - Fax:
Practice Address - Street 1:413 THORNBURG DR SE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8845
Practice Address - Country:US
Practice Address - Phone:828-465-0371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-018-075251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health