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General NPI Number Information
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NPI Number | 1013139187
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Entity Type | Organization
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Legal Business Name | OASIS II -SPECIAL POPULATIONS, INC.
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2317 PRINCE STREET
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City | GEORGETOWN
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State | SC
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Zip | 29440
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Country | US
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Telephone | 843-527-4848
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Fax | 843-527-4838
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Provider Business Mailing Address
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Address Line | 2317 PRINCE STREET
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City | GEORGETOWN
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State | SC
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Zip | 29440
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MAZIE GRAHAM
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Credential |
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Telephone | 843-527-4848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | ADC207
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License Number State | SC
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