Provider Demographics
NPI:1093350357
Name:OASIS MENTAL HEALTH CENTER LLC
Entity Type:Organization
Organization Name:OASIS MENTAL HEALTH CENTER LLC
Other - Org Name:OASIS MEDCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEIVY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-418-9790
Mailing Address - Street 1:5901 NW 183RD ST STE 310
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6008
Mailing Address - Country:US
Mailing Address - Phone:786-418-9790
Mailing Address - Fax:
Practice Address - Street 1:5901 NW 183RD ST STE 310
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6008
Practice Address - Country:US
Practice Address - Phone:786-418-9790
Practice Address - Fax:786-358-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107090600Medicaid
FL104765400Medicaid