Healthcare Provider Details

I. General information

NPI: 1205657517
Provider Name (Legal Business Name): OPPORTUNITY VILLAGE AND HEALING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 12/09/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7618 CORAL KEY DR
CYPRESS TX
77433-6282
US

IV. Provider business mailing address

11407 LYNDENWOOD CT
CHESTERFIELD VA
23838-5263
US

V. Phone/Fax

Practice location:
  • Phone: 336-534-1780
  • Fax:
Mailing address:
  • Phone: 336-534-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RICARDO MARSH
Title or Position: OWNER
Credential:
Phone: 336-534-1780