Provider Demographics
NPI:1346841236
Name:GOLDEN OASIS HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:GOLDEN OASIS HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:FACHECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORT
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CRNP
Authorized Official - Phone:336-259-2865
Mailing Address - Street 1:333 OLD LINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2407
Mailing Address - Country:US
Mailing Address - Phone:336-259-2865
Mailing Address - Fax:
Practice Address - Street 1:333 OLD LINE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2407
Practice Address - Country:US
Practice Address - Phone:336-259-2865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty