Provider Demographics
NPI:1851129829
Name:GODWIN INCORPORATIVE SERVICES
Entity type:Organization
Organization Name:GODWIN INCORPORATIVE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADVISER
Authorized Official - Prefix:DR
Authorized Official - First Name:IKPONMWOSA
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:OGBEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-704-1521
Mailing Address - Street 1:5865 61ST ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-3122
Mailing Address - Country:US
Mailing Address - Phone:707-704-1521
Mailing Address - Fax:
Practice Address - Street 1:5865 61ST ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95824-3122
Practice Address - Country:US
Practice Address - Phone:707-704-1521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities