Provider Demographics
NPI:1225577653
Name:OASIS AT DODGE PARK, LLC
Entity Type:Organization
Organization Name:OASIS AT DODGE PARK, LLC
Other - Org Name:OASIS AT DODGE PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-853-8180
Mailing Address - Street 1:102 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2465
Mailing Address - Country:US
Mailing Address - Phone:508-853-8180
Mailing Address - Fax:
Practice Address - Street 1:102 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2465
Practice Address - Country:US
Practice Address - Phone:508-853-8180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1Q1H311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility