Provider Demographics
NPI:1689836801
Name:OASIS UNLIMITED
Entity Type:Organization
Organization Name:OASIS UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SIGNAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-350-0389
Mailing Address - Street 1:341 SHARPE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-8648
Mailing Address - Country:US
Mailing Address - Phone:336-350-0389
Mailing Address - Fax:336-222-5998
Practice Address - Street 1:1146 N CHURCH ST
Practice Address - Street 2:SUITE F
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2702
Practice Address - Country:US
Practice Address - Phone:336-350-0389
Practice Address - Fax:336-222-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-29
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-001-160251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL-001-160Medicaid