Provider Demographics
NPI:1922483395
Name:K-BEE HOMCARE SERVICES, LLC
Entity Type:Organization
Organization Name:K-BEE HOMCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-762-9356
Mailing Address - Street 1:210 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-7553
Mailing Address - Country:US
Mailing Address - Phone:575-762-9356
Mailing Address - Fax:575-763-3652
Practice Address - Street 1:210 N MAIN ST
Practice Address - Street 2:901 FAIRMONT COURT
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-7553
Practice Address - Country:US
Practice Address - Phone:575-762-9356
Practice Address - Fax:575-763-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1407154941Medicaid