MEDICARE: ENRICHMENT OASIS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1396570149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENRICHMENT OASIS

Provider Business Mailing Address
First Line	:	4408 LAVENDER LN
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4265
Country	:	US
Telephone Number	:	240-565-7769
Fax Number	:

Provider Business Practice Location Address
First Line	:	4408 LAVENDER LN
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4265
Country	:	US
Telephone Number	:	240-565-7769
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	KERNIE LEANDRA ROBIN-OZUZU
Credential	:
Telephone Number	:	240-565-7769

Provider Enumeration Date	:	09/03/2024
Last Update Date	:	09/05/2024

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