Provider Demographics
NPI:1275775694
Name:GULFSTREAM GOODWILL INDUSTRIES, INC.
Entity Type:Organization
Organization Name:GULFSTREAM GOODWILL INDUSTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, HUMAN SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-848-7200
Mailing Address - Street 1:1715 TIFFANY DR E
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3224
Mailing Address - Country:US
Mailing Address - Phone:561-848-7200
Mailing Address - Fax:561-848-0346
Practice Address - Street 1:1715 TIFFANY DR E
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3224
Practice Address - Country:US
Practice Address - Phone:561-848-7200
Practice Address - Fax:561-848-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management