MEDICARE: MENTAL OASIS LLC

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	251B00000X	Case Management Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1801680947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL OASIS LLC

Provider Business Mailing Address
First Line	:	6 W PARK AVE UNIT 1363
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-6257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 W PARK AVE UNIT 1363
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-6257
Country	:	US
Telephone Number	:	352-593-3853
Fax Number	:

Authorized Official
Title or Position	:	EMPLOYEE
Name	:	L C. RIVERA
Credential	:
Telephone Number	:	352-593-3853

Provider Enumeration Date	:	04/05/2025
Last Update Date	:	02/04/2026

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