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General NPI Number Information
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NPI Number | 1487260584
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Entity Type | Organization
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Legal Business Name | ROSE GODWIN SUPPORT SERVICES, INC
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 13671 BALTIMORE AVE
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City | LAUREL
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State | MD
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Zip | 20707-5096
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Country | US
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Telephone | 301-907-1700
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Fax | 877-714-8747
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Provider Business Mailing Address
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Address Line | 11226 CHERRY HILL RD APT 302
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City | BELTSVILLE
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State | MD
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Zip | 20705-3831
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Country | US
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Telephone | 301-907-1700
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Fax | 877-714-8747
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | AYO OKORO
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Credential |
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Telephone | 301-907-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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