Healthcare Provider Details

I. General information

NPI: 1336906684
Provider Name (Legal Business Name): THE OASIS FOR HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 LAPORTE AVE
FORT COLLINS CO
80521-2422
US

IV. Provider business mailing address

1160 LAPORTE AVE
FORT COLLINS CO
80521-2422
US

V. Phone/Fax

Practice location:
  • Phone: 507-269-9391
  • Fax: 970-821-8466
Mailing address:
  • Phone: 507-269-9391
  • Fax: 970-821-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK HAROLD WINEMILLER
Title or Position: MANAGER, OWNER
Credential: MD
Phone: 507-269-9391