1023285384 NPI number — OASIS OF PEACE, LLC

Table of content: (NPI 1023285384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023285384 NPI number — OASIS OF PEACE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OASIS OF PEACE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023285384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98353-0220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-874-2727
Provider Business Mailing Address Fax Number:
360-871-6382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1008 BETHEL AVE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366-4235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-874-2727
Provider Business Practice Location Address Fax Number:
360-871-6382
Provider Enumeration Date:
05/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STRODE
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MEMBER/MANAGER
Authorized Official Telephone Number:
360-874-2727

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA00013613 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com