Provider Demographics
NPI:1124679436
Name:DOCTORS GOODWILL FOUNDATION, INC
Entity type:Organization
Organization Name:DOCTORS GOODWILL FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KANTILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BHALANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-298-5531
Mailing Address - Street 1:3 INDIAN RIVER AVE APT 1001
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-5821
Mailing Address - Country:US
Mailing Address - Phone:321-298-5531
Mailing Address - Fax:
Practice Address - Street 1:123 S PARK AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3377
Practice Address - Country:US
Practice Address - Phone:321-567-4869
Practice Address - Fax:321-567-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health