Healthcare Provider Details

I. General information

NPI: 1972280931
Provider Name (Legal Business Name): OASIS OF DELAWARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 BROWNING CIR
MIDDLETOWN DE
19709-1662
US

IV. Provider business mailing address

59 BROWNING CIR
MIDDLETOWN DE
19709-1662
US

V. Phone/Fax

Practice location:
  • Phone: 302-373-1774
  • Fax:
Mailing address:
  • Phone: 302-373-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE ADDISON
Title or Position: ASSISTANT CEO
Credential:
Phone: 302-373-1774