Provider Demographics
NPI:1467875179
Name:AN OASIS OF HOPE LLC
Entity Type:Organization
Organization Name:AN OASIS OF HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:RODGERS
Authorized Official - Last Name:GLORIOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-789-0793
Mailing Address - Street 1:306 W GRANT ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-6828
Mailing Address - Country:US
Mailing Address - Phone:813-704-5901
Mailing Address - Fax:813-704-4085
Practice Address - Street 1:306 W GRANT ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-6828
Practice Address - Country:US
Practice Address - Phone:813-704-5901
Practice Address - Fax:813-704-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11771310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL11771OtherACHA