Provider Demographics
NPI:1710600010
Name:OASIS DAY CLUB LLC
Entity Type:Organization
Organization Name:OASIS DAY CLUB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DONA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAGGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-579-6752
Mailing Address - Street 1:12170 SAYLOR RD NW
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43105-9413
Mailing Address - Country:US
Mailing Address - Phone:614-579-6752
Mailing Address - Fax:
Practice Address - Street 1:12170 SAYLOR RD NW
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:43105-9413
Practice Address - Country:US
Practice Address - Phone:614-579-6752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2305231Medicaid