1487260584 NPI number — ROSE GODWIN SUPPORT SERVICES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487260584 NPI number — ROSE GODWIN SUPPORT SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSE GODWIN SUPPORT SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487260584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11226 CHERRY HILL RD APT 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20705-3831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-907-1700
Provider Business Mailing Address Fax Number:
877-714-8747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13671 BALTIMORE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20707-5096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-907-1700
Provider Business Practice Location Address Fax Number:
877-714-8747
Provider Enumeration Date:
09/23/2020

Additional Information

Authorized Official

Authorized Official Last Name:
OKORO
Authorized Official First Name:
AYO
Authorized Official Middle Name:
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
301-907-1700

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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