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General NPI Number Information
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NPI Number | 1568398667
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Entity Type | Organization
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Legal Business Name | MARY'S HOUSE LLC
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Dates
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Enumeration Date | 06/18/2026
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Last Update Date | 06/18/2026
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Provider Practice Location Address
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Address Line | 1025 ARIZONA DR
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City | RICHMOND
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State | VA
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Zip | 23224-1732
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Country | US
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Telephone | 804-339-5247
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 37061
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23234-7061
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Country | US
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Telephone | 804-339-5247
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LETICIA MOSBY
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Credential |
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Telephone | 804-339-5247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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