Provider Demographics
NPI:1407154941
Name:GODWIN, MARVIN DWIGHT
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:DWIGHT
Last Name:GODWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W 5TH STREET
Mailing Address - Street 2:K-BEE HOMECARE SERVICES LLC
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-7302
Mailing Address - Country:US
Mailing Address - Phone:575-762-9356
Mailing Address - Fax:575-763-3652
Practice Address - Street 1:106 W 5TH ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-7302
Practice Address - Country:US
Practice Address - Phone:575-762-9352
Practice Address - Fax:575-763-3652
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM88127303Medicaid