MEDICARE: GULFSTREAM GOODWILL INDUSTRIES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1275775694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULFSTREAM GOODWILL INDUSTRIES, INC.

Provider Business Mailing Address
First Line	:	1715 TIFFANY DR E
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3224
Country	:	US
Telephone Number	:	561-848-7200
Fax Number	:	561-848-0346

Provider Business Practice Location Address
First Line	:	1715 TIFFANY DR E
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3224
Country	:	US
Telephone Number	:	561-848-7200
Fax Number	:	561-848-0346

Authorized Official
Title or Position	:	VP, HUMAN SERVICES
Name	:	MRS. KATHRYN SPENCER
Credential	:
Telephone Number	:	561-848-7200

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	03/31/2009

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