Provider Demographics
NPI:1629773874
Name:GOSS, CAROL (CEO)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:GOSS
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 212684
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33421-2684
Mailing Address - Country:US
Mailing Address - Phone:561-305-3466
Mailing Address - Fax:
Practice Address - Street 1:783 LILAC DR
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3438
Practice Address - Country:US
Practice Address - Phone:561-305-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home