Healthcare Provider Details

I. General information

NPI: 1568398667
Provider Name (Legal Business Name): MARY'S HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 ARIZONA DR
RICHMOND VA
23224-1732
US

IV. Provider business mailing address

PO BOX 37061
NORTH CHESTERFIELD VA
23234-7061
US

V. Phone/Fax

Practice location:
  • Phone: 804-339-5247
  • Fax:
Mailing address:
  • Phone: 804-339-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LETICIA MOSBY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 804-339-5247