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Provider Demographic Information - GOODWILL INDUSTRIES OF NEPA INC

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PROVIDER DEMOGRAPHIC INFORMATION Supporting line for group header


Name:	GOODWILL INDUSTRIES OF NEPA INC
Address:	925 PROSPECT AVE SCRANTON, PA 18505-1858
Phone:	(570) 343-1166
Web Site:	www.goodwillnepa.com

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PROVIDER CERTIFICATION INFORMATION Supporting line for group header

Click here to view Provider Certification Information

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PROVIDER'S PARENT/ REGIONAL OFFICE Supporting line for group header


Type:	Corporate Office
Name:	GOODWILL INDUSTRIES OF NORHTEASTERN PA INC.
Address:	925 PROSPECT AVE SCRANTON, PA 18505-1858
Phone:	(570) 343-1166
Fax:	(570) 343-6765

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PROVIDER SERVICES AND RATES Supporting line for group header


County : Allegheny
\|Service Name / Level	\|Rate

CPS (1:1 to 1:5) Remote	$5.34 / 15 min.
CPS (1:6 or >) Remote	$2.06 / 15 min.
CPS Community 1:1	$13.83 / 15 min.
CPS Community 1:2 or 1:3	$7.54 / 15 min.
CPS Facility 1:1	$13.39 / 15 min.
CPS Facility 1:2 to 1:3	$7.39 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
Small Group Employment (Level 2)-15 min	$7.52 / 15 min.
Small Group Employment (Level 3)-15 Mins	$14.20 / 15 min.
Transportation(Zone 1)-Trip	$36.54 / Trip
Transportation(Zone 2)-Trip	$65.78 / Trip
Transportation(Zone 3)-Trip	$74.73 / Trip

County : Carbon/Monroe/Pike
\|Service Name / Level	\|Rate

Behavioral Supports-Level 1-Initial/Ongoing	$23.85 / 15 min.
CPS Community 1:1	$13.83 / 15 min.
CPS Community 1:2 or 1:3	$7.54 / 15 min.
CPS Community 2:1	$26.59 / 15 min.
CPS Community 2:3	$11.26 / 15 min.
CPS Facility 1:1	$13.39 / 15 min.
CPS Facility 1:1 Enhanced	$18.65 / 15 min.
CPS Facility 1:1 Enhcd LPN	$18.65 / 15 min.
CPS Facility 1:1 Enhcd RN	$18.65 / 15 min.
CPS Facility 1:11 to 1:15	$3.20 / 15 min.
CPS Facility 1:2 to 1:3	$7.39 / 15 min.
CPS Facility 1:4 to 1:6	$5.65 / 15 min.
CPS Facility 1:7 to 1:10	$3.43 / 15 min.
CPS Facility 2:1	$25.67 / 15 min.
CPS Facility 2:1 Enhcd	$30.94 / 15 min.
CPS Facility 2:1 Enhcd LPN	$30.94 / 15 min.
CPS Facility 2:1 Enhcd RN	$30.94 / 15 min.
CPS:Community OnCall/Remote Support	$1.77 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.42 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$6.22 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$11.10 / 15 min.
Res Hab-4 Person-NG 1-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 2-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 3-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 4-Elig-w/Day Supports	Not Set
Res Hab-Lic-4 Person-Elig-NG 1	Not Set
Res Hab-Lic-4 Person-Elig-NG 2	Not Set
Res Hab-Lic-4 Person-Elig-NG 3	Not Set
Res Hab-Lic-4 Person-Elig-NG 4	Not Set
Res Hab-Lic-4 Person-Inelig	Not Set
Small Group Employment (Base)-15 min	$2.48 / 15 min.
Small Group Employment (Level 1)-15 min	$3.82 / 15 min.
Small Group Employment (Level 2)-15 min	$7.52 / 15 min.
Supplemental Habilitation 1:1 - 15 min	Not Set
Supported Employment-Career Assessment	$19.34 / 15 min.
Supported Emplymnt-Job Finding/Job Development	$19.34 / 15 min.
Supported Emplymnt-Job Support - 1:1	$19.34 / 15 min.
Transportation(Zone 1)-Trip	$36.54 / Trip
Transportation(Zone 2)-Trip	$65.78 / Trip
Transportation(Zone 3)-Trip	$74.73 / Trip

County : Lackawanna/Susquehanna
\|Service Name / Level	\|Rate

Behavioral Supports-Level 1-Initial/Ongoing	$23.85 / 15 min.
CPS (1:1 to 1:5) Remote	$5.34 / 15 min.
CPS (1:6 or >) Remote	$2.06 / 15 min.
CPS Community 1:1	$13.83 / 15 min.
CPS Community 1:2 or 1:3	$7.54 / 15 min.
CPS Community 2:1	$26.59 / 15 min.
CPS Community 2:3	$11.26 / 15 min.
CPS Facility 1:1	$13.39 / 15 min.
CPS Facility 1:1 Enhanced	$18.65 / 15 min.
CPS Facility 1:1 Enhcd LPN	$18.65 / 15 min.
CPS Facility 1:1 Enhcd RN	$18.65 / 15 min.
CPS Facility 1:11 to 1:15	$3.20 / 15 min.
CPS Facility 1:2 to 1:3	$7.39 / 15 min.
CPS Facility 1:4 to 1:6	$5.65 / 15 min.
CPS Facility 1:7 to 1:10	$3.43 / 15 min.
CPS Facility 2:1	$25.67 / 15 min.
CPS Facility 2:1 Enhcd	$30.94 / 15 min.
CPS Facility 2:1 Enhcd LPN	$30.94 / 15 min.
CPS Facility 2:1 Enhcd RN	$30.94 / 15 min.
CPS:Community OnCall/Remote Support	$1.77 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.42 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$6.22 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$11.10 / 15 min.
Res Hab-1 Person-NG 1-Elig	Not Set
Res Hab-1 Person-NG 1-Elig-w/Day Supports	Not Set
Res Hab-1 Person-NG 2-Elig	Not Set
Res Hab-1 Person-NG 2-Elig-w/Day Supports	Not Set
Res Hab-1 Person-NG 3-Elig	Not Set
Res Hab-1 Person-NG 3-Elig-w/Day Supports	Not Set
Res Hab-1 Person-NG 4-Elig	Not Set
Res Hab-1 Person-NG 4-Elig-w/Day Supports	Not Set
Res Hab-3 Person-NG 1-Elig	Not Set
Res Hab-3 Person-NG 1-Elig-w/Day Supports	Not Set
Res Hab-3 Person-NG 2-Elig	Not Set
Res Hab-3 Person-NG 2-Elig-w/Day Supports	Not Set
Res Hab-3 Person-NG 3-Elig	Not Set
Res Hab-3 Person-NG 3-Elig-w/Day Supports	Not Set
Res Hab-3 Person-NG 4-Elig	Not Set
Res Hab-3 Person-NG 4-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 1-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 2-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 3-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 4-Elig-w/Day Supports	Not Set
Res Hab-Lic-1 Person-Inelig	Not Set
Res Hab-Lic-3 Person-Inelig	Not Set
Res Hab-Lic-4 Person-Elig-NG 1	Not Set
Res Hab-Lic-4 Person-Elig-NG 2	Not Set
Res Hab-Lic-4 Person-Elig-NG 3	Not Set
Res Hab-Lic-4 Person-Elig-NG 4	Not Set
Res Hab-Lic-4 Person-Inelig	Not Set
Small Group Employment (Level 1)-15 min	$3.82 / 15 min.
Small Group Employment (Level 2)-15 min	$7.52 / 15 min.
Small Group Employment (Level 3)-15 Mins	$14.20 / 15 min.
Supplemental Habilitation 1:1 - 15 min	Not Set
Supplemental Habilitation 2:1 - 15 min	Not Set
Support (Medical Environment) (Level 3)-15 Mins	Not Set
Supported Employment-Career Assessment	$19.34 / 15 min.
Supported Emplymnt-Job Finding/Job Development	$19.34 / 15 min.
Supported Emplymnt-Job Support - 1:1	$19.34 / 15 min.
Transportation(Zone 1)-Trip	$36.54 / Trip
Transportation(Zone 2)-Trip	$65.78 / Trip

County : Lebanon
\|Service Name / Level	\|Rate

Behavioral Supports-Level 1-Initial/Ongoing	$23.85 / 15 min.

County : Luzerne/Wyoming
\|Service Name / Level	\|Rate

Behavioral Supports-Level 1-Initial/Ongoing	$23.85 / 15 min.
CPS (1:1 to 1:5) Remote	$5.34 / 15 min.
CPS (1:6 or >) Remote	$2.06 / 15 min.
CPS Community 1:1	$13.83 / 15 min.
CPS Community 1:2 or 1:3	$7.54 / 15 min.
CPS Community 2:1	$26.59 / 15 min.
CPS Community 2:3	$11.26 / 15 min.
CPS Facility 1:1	$13.39 / 15 min.
CPS Facility 1:1 Enhanced	$18.65 / 15 min.
CPS Facility 1:1 Enhcd LPN	$18.65 / 15 min.
CPS Facility 1:1 Enhcd RN	$18.65 / 15 min.
CPS Facility 1:11 to 1:15	$3.20 / 15 min.
CPS Facility 1:2 to 1:3	$7.39 / 15 min.
CPS Facility 1:4 to 1:6	$5.65 / 15 min.
CPS Facility 1:7 to 1:10	$3.43 / 15 min.
CPS Facility 2:1	$25.67 / 15 min.
CPS Facility 2:1 Enhcd	$30.94 / 15 min.
CPS Facility 2:1 Enhcd LPN	$30.94 / 15 min.
CPS Facility 2:1 Enhcd RN	$30.94 / 15 min.
CPS:Community OnCall/Remote Support	$1.77 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
Res Hab-1 Person-NG 1-Elig	Not Set
Res Hab-1 Person-NG 1-Elig-w/Day Supports	Not Set
Res Hab-1 Person-NG 2-Elig	Not Set
Res Hab-1 Person-NG 2-Elig-w/Day Supports	Not Set
Res Hab-1 Person-NG 3-Elig	Not Set
Res Hab-1 Person-NG 3-Elig-w/Day Supports	Not Set
Res Hab-1 Person-NG 4-Elig	Not Set
Res Hab-1 Person-NG 4-Elig-w/Day Supports	Not Set
Res Hab-3 Person-NG 1-Elig	Not Set
Res Hab-3 Person-NG 1-Elig-w/Day Supports	Not Set
Res Hab-3 Person-NG 2-Elig	Not Set
Res Hab-3 Person-NG 2-Elig-w/Day Supports	Not Set
Res Hab-3 Person-NG 3-Elig	Not Set
Res Hab-3 Person-NG 3-Elig-w/Day Supports	Not Set
Res Hab-3 Person-NG 4-Elig	Not Set
Res Hab-3 Person-NG 4-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 1-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 2-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 3-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 4-Elig-w/Day Supports	Not Set
Res Hab-Lic-1 Person-Inelig	Not Set
Res Hab-Lic-3 Person-Inelig	Not Set
Res Hab-Lic-4 Person-Elig-NG 1	Not Set
Res Hab-Lic-4 Person-Elig-NG 2	Not Set
Res Hab-Lic-4 Person-Elig-NG 3	Not Set
Res Hab-Lic-4 Person-Elig-NG 4	Not Set
Res Hab-Lic-4 Person-Inelig	Not Set
Small Group Employment (Level 1)-15 min	$3.82 / 15 min.
Small Group Employment (Level 2)-15 min	$7.52 / 15 min.
Small Group Employment (Level 3)-15 Mins	$14.20 / 15 min.
Supplemental Habilitation 1:1 - 15 min	Not Set
Supplemental Habilitation 2:1 - 15 min	Not Set
Supported Employment-Career Assessment	$19.34 / 15 min.
Supported Emplymnt-Job Finding/Job Development	$19.34 / 15 min.
Supported Emplymnt-Job Support - 1:1	$19.34 / 15 min.
Transportation(Zone 1)-Trip	$36.54 / Trip
Transportation(Zone 2)-Trip	$65.78 / Trip
Transportation(Zone 3)-Trip	$74.73 / Trip

County : Lycoming/Clinton
\|Service Name / Level	\|Rate

CPS Community 1:2 or 1:3	$7.54 / 15 min.
CPS Facility 1:2 to 1:3	$7.39 / 15 min.
Res Hab-4 Person-NG 1-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 2-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 3-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 4-Elig-w/Day Supports	Not Set
Res Hab-Lic-4 Person-Elig-NG 1	Not Set
Res Hab-Lic-4 Person-Elig-NG 2	Not Set
Res Hab-Lic-4 Person-Elig-NG 3	Not Set
Res Hab-Lic-4 Person-Elig-NG 4	Not Set
Res Hab-Lic-4 Person-Inelig	Not Set
Small Group Employment (Level 1)-15 min	$3.82 / 15 min.
Small Group Employment (Level 2)-15 min	$7.52 / 15 min.
Small Group Employment (Level 3)-15 Mins	$14.20 / 15 min.

County : Northampton
\|Service Name / Level	\|Rate

Behavioral Supports-Level 1-Initial/Ongoing	$23.85 / 15 min.
Res Hab-4 Person-NG 1-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 2-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 3-Elig-w/Day Supports	Not Set
Res Hab-4 Person-NG 4-Elig-w/Day Supports	Not Set
Res Hab-Lic-4 Person-Elig-NG 1	Not Set
Res Hab-Lic-4 Person-Elig-NG 2	Not Set
Res Hab-Lic-4 Person-Elig-NG 3	Not Set
Res Hab-Lic-4 Person-Elig-NG 4	Not Set
Res Hab-Lic-4 Person-Inelig	Not Set
Supplemental Habilitation 1:1 - 15 min	Not Set

County : Wayne
\|Service Name / Level	\|Rate

Behavioral Supports-Level 1-Initial/Ongoing	$23.85 / 15 min.
CPS (1:1 to 1:5) Remote	$5.34 / 15 min.
CPS (1:6 or >) Remote	$2.06 / 15 min.
CPS Community 1:1	$13.83 / 15 min.
CPS Community 1:2 or 1:3	$7.54 / 15 min.
CPS Community 2:3	$11.26 / 15 min.
CPS Facility 1:1	$13.39 / 15 min.
CPS Facility 1:1 Enhanced	$18.65 / 15 min.
CPS Facility 1:1 Enhcd LPN	$18.65 / 15 min.
CPS Facility 1:1 Enhcd RN	$18.65 / 15 min.
CPS Facility 1:11 to 1:15	$3.20 / 15 min.
CPS Facility 1:2 to 1:3	$7.39 / 15 min.
CPS Facility 1:4 to 1:6	$5.65 / 15 min.
CPS Facility 1:7 to 1:10	$3.43 / 15 min.
CPS Facility 2:1	$25.67 / 15 min.
CPS Facility 2:1 Enhcd	$30.94 / 15 min.
CPS Facility 2:1 Enhcd LPN	$30.94 / 15 min.
CPS Facility 2:1 Enhcd RN	$30.94 / 15 min.
CPS:Community OnCall/Remote Support	$1.77 / 15 min.
Companion Services (Level 1)	$4.77 / 15 min.
Companion Services (Level 2)	$8.33 / 15 min.
Small Group Employment (Level 1)-15 min	$3.82 / 15 min.
Small Group Employment (Level 2)-15 min	$7.52 / 15 min.
Small Group Employment (Level 3)-15 Mins	$14.20 / 15 min.
Supported Employment-Career Assessment	$19.34 / 15 min.
Supported Emplymnt-Job Finding/Job Development	$19.34 / 15 min.
Supported Emplymnt-Job Support - 1:1	$19.34 / 15 min.
Transportation(Zone 1)-Trip	$36.54 / Trip

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