Healthcare Provider Details

I. General information

NPI: 1477444842
Provider Name (Legal Business Name): SPRING CREEK OASIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 HEACOCK ST STE C234
MORENO VALLEY CA
92553-3364
US

IV. Provider business mailing address

13800 HEACOCK ST STE C234
MORENO VALLEY CA
92553-3364
US

V. Phone/Fax

Practice location:
  • Phone: 323-816-2755
  • Fax: 877-341-4477
Mailing address:
  • Phone: 323-816-2755
  • Fax: 877-341-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHARLES STEWART
Title or Position: ADMINISTRATOR/DIRECTOR
Credential:
Phone: 323-816-2755