Healthcare Provider Details

I. General information

NPI: 1548272099
Provider Name (Legal Business Name): OASIS CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 COMMERCE PL FL 4
ELIZABETH NJ
07201-2320
US

IV. Provider business mailing address

208 COMMERCE PL FL 4
ELIZABETH NJ
07201-2320
US

V. Phone/Fax

Practice location:
  • Phone: 908-372-3000
  • Fax: 908-372-3009
Mailing address:
  • Phone: 908-372-3000
  • Fax: 908-372-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2000191
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number2000191
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number2000191
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number2000191
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number2000191
License Number StateNJ

VIII. Authorized Official

Name: MR. MATTHEW M THOMPSON
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 908-372-3000