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General NPI Number Information
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NPI Number | 1114281771
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Entity Type | Organization
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Legal Business Name | THE OASIS HOME II LLC
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 845 W CALLE BARBITAS
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City | SAHUARITA
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State | AZ
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Zip | 85629-7907
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Country | US
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Telephone | 520-777-5215
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Fax | 520-777-6391
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Provider Business Mailing Address
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Address Line | 11124 W DENIER DR
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City | MARANA
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State | AZ
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Zip | 85653-8270
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Country | US
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Telephone | 520-270-7055
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. EMMANUEL MOUNKAM
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Credential |
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Telephone | 520-270-7055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | BH-4044
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License Number State | AZ
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