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General NPI Number Information
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NPI Number | 1447733043
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Entity Type | Organization
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Legal Business Name | HIDDEN OASIS, LLC
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 6081 N DODGE DR
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1742
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Country | US
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Telephone | 928-273-4442
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Fax |
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Provider Business Mailing Address
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Address Line | 6081 N DODGE DR
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1742
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Country | US
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Telephone | 928-273-4442
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KARL HENDERSON
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Credential |
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Telephone | 928-273-4442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number |
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License Number State |
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