=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548947831
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OASIS VENTURES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2023
-----------------------------------------------------
Last Update Date | 06/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | W177N9886 RIVERCREST DR STE 262
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53022-6407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-894-1894
-----------------------------------------------------
Fax | 262-255-2244
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1234 NEW YORK AVE
-----------------------------------------------------
City | SHEBOYGAN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53081-3903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-894-1894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. PETE GAHAGAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 920-894-1894
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------