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General NPI Number Information
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NPI Number | 1952848368
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Entity Type | Organization
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Legal Business Name | MA'RRU OASIS
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 11610 SUMMERFIELD CT
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-6040
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Country | US
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Telephone | 540-903-8723
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Fax |
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Provider Business Mailing Address
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Address Line | 11610 SUMMERFIELD CT
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-6040
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Country | US
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Telephone | 540-903-8723
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JEWEL LUMAURE WIGGLESWORTH
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Credential | CNA
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Telephone | 540-903-8723
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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 | NC
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | NC
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