Provider Demographics
NPI:1952848368
Name:MA'RRU OASIS
Entity Type:Organization
Organization Name:MA'RRU OASIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEWEL
Authorized Official - Middle Name:LUMAURE
Authorized Official - Last Name:WIGGLESWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:540-903-8723
Mailing Address - Street 1:11610 SUMMERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6040
Mailing Address - Country:US
Mailing Address - Phone:540-903-8723
Mailing Address - Fax:
Practice Address - Street 1:11610 SUMMERFIELD CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6040
Practice Address - Country:US
Practice Address - Phone:540-903-8723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320800000X, 320900000X, 385H00000X
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA223497601Medicaid