Healthcare Provider Details

I. General information

NPI: 1083869994
Provider Name (Legal Business Name): GODWIN HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 NW 15TH AVE
OCALA FL
34475-5027
US

IV. Provider business mailing address

1215 NW 15TH AVE
OCALA FL
34475-5027
US

V. Phone/Fax

Practice location:
  • Phone: 352-620-8988
  • Fax: 352-629-5344
Mailing address:
  • Phone: 352-620-8988
  • Fax: 352-629-5344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberL06000033171
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberL06000033171
License Number StateFL

VIII. Authorized Official

Name: MRS. ROSEMARY GRAHAM GODWIN
Title or Position: OWNER
Credential:
Phone: 352-484-4131