Provider Demographics
NPI:1275901175
Name:OASIS PAVILION NURSING AND REHABILITATION CENTER LLC-OTC
Entity Type:Organization
Organization Name:OASIS PAVILION NURSING AND REHABILITATION CENTER LLC-OTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:U
Authorized Official - Last Name:OPARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-836-1772
Mailing Address - Street 1:161 W RODEO RD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6201
Mailing Address - Country:US
Mailing Address - Phone:520-836-1772
Mailing Address - Fax:520-421-4966
Practice Address - Street 1:161 W RODEO RD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6201
Practice Address - Country:US
Practice Address - Phone:520-836-1772
Practice Address - Fax:520-421-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI-2692314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035276Medicare Oscar/Certification