MEDICARE: OASIS BEHAVIORAL HEALTH, INC.

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09-00009098	OTHER	CA	CITY OF INDIO BIZ LICENSE

General Provider Information

NPI Number	:	1780861500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OASIS BEHAVIORAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	81557 DOCTOR CARREON BLVD.
Second Line	:	SUITE C-8 AND C-9
City	:	INDIO
State	:	CA
Zip	:	92201-5562
Country	:	US
Telephone Number	:	760-391-6999
Fax Number	:

Provider Business Practice Location Address
First Line	:	81557 DOCTOR CARREON BLVD.
Second Line	:	SUITE C-8 AND C-9
City	:	INDIO
State	:	CA
Zip	:	92201-5562
Country	:	US
Telephone Number	:	760-391-6999
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CHIEF EXECUTIVE OFFIC
Name	:	KENT DUNLAP
Credential	:
Telephone Number	:	310-221-6336

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	03/26/2018

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