Provider Demographics
NPI:1689909541
Name:OASIS HEALTHCARE AND THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:OASIS HEALTHCARE AND THERAPEUTIC SERVICES
Other - Org Name:OASIS HEALTHCARE AND THERAPEUTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-213-6225
Mailing Address - Street 1:1101 TYVOLA RD
Mailing Address - Street 2:301
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3515
Mailing Address - Country:US
Mailing Address - Phone:704-213-6225
Mailing Address - Fax:704-216-1406
Practice Address - Street 1:1101 TYVOLA RD
Practice Address - Street 2:301
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3515
Practice Address - Country:US
Practice Address - Phone:704-213-6225
Practice Address - Fax:704-216-1406
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OASIS HEALTHCARE AND THERAPEUTIC SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-12
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4362251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601898Medicaid