Provider Demographics
NPI:1053890111
Name:ROSE GODWIN SUPPORT SERVICES, INC
Entity type:Organization
Organization Name:ROSE GODWIN SUPPORT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AYO
Authorized Official - Middle Name:
Authorized Official - Last Name:OKORO
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:301-907-1700
Mailing Address - Street 1:11226 CHERRY HILL RD APT 302
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3831
Mailing Address - Country:US
Mailing Address - Phone:301-907-1700
Mailing Address - Fax:877-714-8747
Practice Address - Street 1:11226 CHERRY HILL RD APT 302
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3831
Practice Address - Country:US
Practice Address - Phone:301-907-1700
Practice Address - Fax:877-714-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care