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General NPI Number Information
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NPI Number | 1679445191
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Entity Type | Organization
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Legal Business Name | OASIS OF GROWTH BEHAVIORAL SERVICES LLC
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 561 SW LAKOTA AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-3056
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Country | US
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Telephone | 561-215-1038
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Fax |
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Provider Business Mailing Address
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Address Line | 561 SW LAKOTA AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-3056
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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 | CHRISTOPHER CAINES
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Credential |
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Telephone | 561-410-6911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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