Healthcare Provider Details

I. General information

NPI: 1922483395
Provider Name (Legal Business Name): K-BEE HOMCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N MAIN ST 901 FAIRMONT COURT
CLOVIS NM
88101-7553
US

IV. Provider business mailing address

210 N MAIN ST
CLOVIS NM
88101-7553
US

V. Phone/Fax

Practice location:
  • Phone: 575-762-9356
  • Fax: 575-763-3652
Mailing address:
  • Phone: 575-762-9356
  • Fax: 575-763-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MR. MARVIN DWIGHT GODWIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 575-762-9356