Goodwill Greater Cleveland and East Central Ohio

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

GOODWILL GREATER CLEVELAND AND EAST CENTRAL OHIO

Practice address

408 Ninth Street SW
Canton, OH 44707-4714

Phone

(330) 445-1035

Fax

(330) 454-1014

NPI assigned

Apr 20, 2007

Last updated

Dec 2, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Trew

Title

Chief Operating Officer

Phone

(330) 445-1035

Specialties & licenses 5

Addresses

Other identifiers 4

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669939200000",
    "number": "1194943860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 NINTH STREET SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "44707",
            "telephone_number": "330-445-1059",
            "fax_number": "330-454-1014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 NINTH STREET SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447074714",
            "telephone_number": "330-445-1035",
            "fax_number": "330-454-1014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODWILL GREATER CLEVELAND AND EAST CENTRAL OHIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A",
        "authorized_official_last_name": "TREW",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "330-445-1035"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "OH",
            "license": "A00436",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "SP2281",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "SP8183",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "SP3189",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE HEALTH PLAN",
            "identifier": "733018",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE-MEDICAID HMO",
            "identifier": "733018",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3303884",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0303042",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leah Gonzalez, LPCC
• Doreen May Good, CRNP
• Brian Goode
• Breeze M Goodrich, MD
• Season Lee Goodright
• Ni'Kylah Goodwin
• Prabhakaran P Gopalakrishnan, MD
• Adriana Gordon, CT
• Alexander Tauheed Gordon I
• Angela B Gordon, LPN

• Health Service Clinic/Center in Canton, OH
• Providers in Canton, OH by specialty
• Health Service Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.