1114281771 NPI number — THE OASIS HOME II LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114281771 NPI number — THE OASIS HOME II LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE OASIS HOME II 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:
1114281771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11124 W DENIER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARANA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85653-8270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-270-7055
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 W CALLE BARBITAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAHUARITA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85629-7907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-777-5215
Provider Business Practice Location Address Fax Number:
520-777-6391
Provider Enumeration Date:
06/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MOUNKAM
Authorized Official First Name:
EMMANUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
520-270-7055

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  BH-4044 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 182785 . This is a "AHCCCS ID NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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