=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366593436
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OASIS REHABILITATION CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 01/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 47-915 OASIS ST.
-----------------------------------------------------
City | INDIO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92201-6950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-863-8600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47-915 OASIS ST.
-----------------------------------------------------
City | INDIO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92201-6950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-863-8600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. MARY JANE GROSS
-----------------------------------------------------
Credential | RN, MN
-----------------------------------------------------
Telephone | 510-635-9705
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------