Healthcare Provider Details

I. General information

NPI: 1033607726
Provider Name (Legal Business Name): OAK PARK OASIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N HARLEM AVE
OAK PARK IL
60302-1805
US

IV. Provider business mailing address

8131 MONTICELLO AVE
SKOKIE IL
60076-3325
US

V. Phone/Fax

Practice location:
  • Phone: 708-848-5966
  • Fax:
Mailing address:
  • Phone: 773-945-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SHIMON WEBSTER
Title or Position: MANAGER
Credential:
Phone: 773-945-1107