Healthcare Provider Details

I. General information

NPI: 1013398130
Provider Name (Legal Business Name): OASIS LIFECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 MARTIN ST
STATE COLLEGE PA
16803-3058
US

IV. Provider business mailing address

1520 MARTIN ST
STATE COLLEGE PA
16803-3058
US

V. Phone/Fax

Practice location:
  • Phone: 814-883-9949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON M LIEB
Title or Position: EXECUTIVE OFFICER
Credential:
Phone: 814-883-9949