Healthcare Provider Details

I. General information

NPI: 1013139187
Provider Name (Legal Business Name): OASIS II -SPECIAL POPULATIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 PRINCE STREET
GEORGETOWN SC
29440
US

IV. Provider business mailing address

2317 PRINCE STREET
GEORGETOWN SC
29440
US

V. Phone/Fax

Practice location:
  • Phone: 843-527-4848
  • Fax: 843-527-4838
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberADC207
License Number StateSC

VIII. Authorized Official

Name: MS. MAZIE GRAHAM
Title or Position: ADMINISTRATOR
Credential:
Phone: 843-527-4848