Provider Demographics
NPI:1043439151
Name:W & K GOODWIN VENTURES INCORPORATED
Entity type:Organization
Organization Name:W & K GOODWIN VENTURES INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-232-9988
Mailing Address - Street 1:129 DODGE ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1862
Mailing Address - Country:US
Mailing Address - Phone:978-232-9988
Mailing Address - Fax:978-232-9977
Practice Address - Street 1:129 DODGE ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1862
Practice Address - Country:US
Practice Address - Phone:978-232-9988
Practice Address - Fax:978-232-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7142251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health