Provider Demographics
NPI:1891849113
Name:THE OASIS OF LOVE, INC.
Entity Type:Organization
Organization Name:THE OASIS OF LOVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-972-0838
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:ANALOMINK
Mailing Address - State:PA
Mailing Address - Zip Code:18320-0268
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:814 MONROE ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1744
Practice Address - Country:US
Practice Address - Phone:570-972-0838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020311430001Medicaid