Provider Demographics
NPI:1205657517
Name:OPPORTUNITY VILLAGE AND HEALING SERVICES
Entity type:Organization
Organization Name:OPPORTUNITY VILLAGE AND HEALING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-534-1780
Mailing Address - Street 1:11407 LYNDENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5263
Mailing Address - Country:US
Mailing Address - Phone:336-534-1780
Mailing Address - Fax:
Practice Address - Street 1:7618 CORAL KEY DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6282
Practice Address - Country:US
Practice Address - Phone:336-534-1780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-19
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health