Provider Demographics
NPI:1649391939
Name:OASIS CLINICAL CARE MANAGEMENT & CONSULTATION PLLC
Entity Type:Organization
Organization Name:OASIS CLINICAL CARE MANAGEMENT & CONSULTATION PLLC
Other - Org Name:OASIS CLINICAL CARE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEODUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-328-3490
Mailing Address - Street 1:1006 SEBASTIAN CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-3688
Mailing Address - Country:US
Mailing Address - Phone:980-328-3490
Mailing Address - Fax:800-853-9535
Practice Address - Street 1:1006 SEBASTIAN CT
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3688
Practice Address - Country:US
Practice Address - Phone:980-328-3490
Practice Address - Fax:800-853-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005982Medicaid