Organization
MA'RRU OASIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JEWEL LUMAURE WIGGLESWORTH CNA (OWNER)
(540) 903-8723
Entity
Organization
Contact information
Practice address
11610 SUMMERFIELD CT, FREDERICKSBURG, VA 22407-6040
(540) 903-8723
Mailing address
11610 SUMMERFIELD CT, FREDERICKSBURG, VA 22407-6040
(540) 903-8723
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
NC
343900000X
Non-emergency Medical Transport (VAN)
—
VA
385H00000X
Respite Care
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
223497601
—
VA
Enumeration date
01/23/2017
Last updated
01/23/2017
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