Provider Demographics
NPI:1083869994
Name:GODWIN HOUSE LLC
Entity Type:Organization
Organization Name:GODWIN HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-484-4131
Mailing Address - Street 1:1215 NW 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-5027
Mailing Address - Country:US
Mailing Address - Phone:352-620-8988
Mailing Address - Fax:352-629-5344
Practice Address - Street 1:1215 NW 15TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-5027
Practice Address - Country:US
Practice Address - Phone:352-620-8988
Practice Address - Fax:352-629-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL06000033171251C00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690624996Medicaid
FL690951596Medicaid
FL690951598Medicaid