Healthcare Provider Details

I. General information

NPI: 1285016824
Provider Name (Legal Business Name): OASIS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 TYVOLA RD
CHARLOTTE NC
28217-3515
US

IV. Provider business mailing address

1101 TYVOLA RD STE 301
CHARLOTTE NC
28217-3515
US

V. Phone/Fax

Practice location:
  • Phone: 704-213-6225
  • Fax: 704-216-1406
Mailing address:
  • Phone: 704-213-6225
  • Fax: 704-216-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC4362
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TRINA ANTOINETTE FONVILLE
Title or Position: DIRECTOR
Credential:
Phone: 704-213-6225