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General NPI Number Information
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NPI Number | 1710399092
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Entity Type | Organization
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Legal Business Name | OASIS OF LIFE, LTD
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 6920 BRADDOCK ROAD B260
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City | ANNANDALE
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State | VA
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Zip | 22003
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Country | US
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Telephone | 571-274-6460
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Fax |
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Provider Business Mailing Address
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Address Line | 6920 BRADDOCK ROAD B260
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City | ANNANDALE
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State | VA
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Zip | 22003
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Country | US
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Telephone | 571-274-6460
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JOHN STEPHEN GALVIN
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Credential |
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Telephone | 571-274-6460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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