NPIMap

Organization Active NPI

Rose Godwin Support Services, Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Beltsville, MD
National Provider Identifier
1053890111
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
ROSE GODWIN SUPPORT SERVICES, INC
Practice address
11226 Cherry Hill Rd Apt 302
Beltsville, MD 20705-3831
Phone
(301) 907-1700
Fax
(877) 714-8747
NPI assigned
Aug 9, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ayo Okoro, NURSE PRACTITIONERNPI 1972841856
Title
President
Phone
(301) 907-1700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

11226 Cherry Hill Rd Apt 302
Beltsville, MD 20705-3831

Mailing address

11226 Cherry Hill Rd Apt 302
Beltsville, MD 20705-3831
Phone (301) 907-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180822002916 MD Part B Supplier - Clinic/Group Practice 9234488305 Receives reassigned benefits from 2 practitioners
Practice locations: Beltsville, MD
O20190329000855 DC Part B Supplier - Clinic/Group Practice 9234488305 Receives reassigned benefits from 2 practitioners
Practice locations: Beltsville, MD; Laurel, MD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1053890111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11226 CHERRY HILL RD APT 302",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207053831",
            "telephone_number": "301-907-1700",
            "fax_number": "877-714-8747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11226 CHERRY HILL RD APT 302",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207053831",
            "telephone_number": "301-907-1700",
            "fax_number": "877-714-8747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSE GODWIN SUPPORT SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-09",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "OKORO",
        "authorized_official_first_name": "AYO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-907-1700",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beltsville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.