Provider Demographics
NPI:1750656468
Name:OASIS RENEWAL CENTER
Entity Type:Organization
Organization Name:OASIS RENEWAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-372-4611
Mailing Address - Street 1:14913 COOPER ORBIT RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3903
Mailing Address - Country:US
Mailing Address - Phone:501-372-2747
Mailing Address - Fax:501-372-1801
Practice Address - Street 1:14913 COOPER ORBIT RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-3903
Practice Address - Country:US
Practice Address - Phone:501-372-4611
Practice Address - Fax:501-372-1801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECOVERY CENTERS OF ARKANSAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-13
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility