Provider Demographics
NPI:1750648283
Name:ELIM PACIFIC MINISTRIES
Entity Type:Organization
Organization Name:ELIM PACIFIC MINISTRIES
Other - Org Name:OASIS EMPOWERMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:1671-646-4601
Mailing Address - Street 1:556 E MARINE CORPS DR
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96910-5186
Mailing Address - Country:US
Mailing Address - Phone:671-646-4601
Mailing Address - Fax:671-646-5601
Practice Address - Street 1:556 E MARINE CORPS DR
Practice Address - Street 2:
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-5186
Practice Address - Country:US
Practice Address - Phone:671-646-4601
Practice Address - Fax:671-646-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD-14051251B00000X, 251C00000X
GU66--0099324500000X
GU1228019153343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUOASIS1Medicaid