=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831955715
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY OASIS NURSE REGISTRY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2024
-----------------------------------------------------
Last Update Date | 04/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9291 JOHNSON ST
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-6353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-880-4075
-----------------------------------------------------
Fax | 954-391-8570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9291 JOHNSON ST
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-6353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-880-4075
-----------------------------------------------------
Fax | 954-391-8570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARIDELYS MORA ARIAS
-----------------------------------------------------
Credential | RN/ BSN
-----------------------------------------------------
Telephone | 954-880-4075
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------