MEDICARE: THE GUTSTADT GROUP II L.L.C

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	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11493	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1740541986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GUTSTADT GROUP II L.L.C

Provider Business Mailing Address
First Line	:	5517 HAYES ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-4632
Country	:	US
Telephone Number	:	954-534-9401
Fax Number	:

Provider Business Practice Location Address
First Line	:	5517 HAYES ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-4632
Country	:	US
Telephone Number	:	954-534-9401
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MATTHEW GUTSTADT
Credential	:
Telephone Number	:	954-882-3827

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	06/05/2012

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