MEDICARE: SOLACE CARE OASIS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251E00000X	Home Health Agency
3	251J00000X	Nursing Care Agency
4	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1285416230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLACE CARE OASIS LLC

Provider Business Mailing Address
First Line	:	1441 GOLDEN GLOW DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-5465
Country	:	US
Telephone Number	:	239-822-0823
Fax Number	:

Provider Business Practice Location Address
First Line	:	4920 W CYPRESS ST STE 104
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-3837
Country	:	US
Telephone Number	:	239-822-0823
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SHAYNA GLOVER
Credential	:	RN
Telephone Number	:	239-822-0823

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	10/17/2023

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