Provider Demographics
NPI:1013592138
Name:OASIS LIVING ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:OASIS LIVING ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYREETA
Authorized Official - Middle Name:ELISA
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:804-386-5674
Mailing Address - Street 1:6457 GOLDENROD CT
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-5330
Mailing Address - Country:US
Mailing Address - Phone:804-386-5674
Mailing Address - Fax:
Practice Address - Street 1:6457 GOLDENROD CT
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-5330
Practice Address - Country:US
Practice Address - Phone:804-386-5674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility