Provider Demographics
NPI:1003526070
Name:MARY'S OASIS RESIDENTIAL SERVICES, LLC.
Entity Type:Organization
Organization Name:MARY'S OASIS RESIDENTIAL SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DECKION
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-728-9566
Mailing Address - Street 1:PO BOX 42225
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-9225
Mailing Address - Country:US
Mailing Address - Phone:804-728-9566
Mailing Address - Fax:
Practice Address - Street 1:3713 SUNORA DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-1437
Practice Address - Country:US
Practice Address - Phone:804-939-1471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities