Provider Demographics
NPI:1972935542
Name:OASIS OF SERENITY PARTNERS, LLC
Entity Type:Organization
Organization Name:OASIS OF SERENITY PARTNERS, LLC
Other - Org Name:MAYFLOWER THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:AZMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-613-6111
Mailing Address - Street 1:209 E WILLIAM ST STE 104A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-4017
Mailing Address - Country:US
Mailing Address - Phone:316-613-6111
Mailing Address - Fax:316-613-6113
Practice Address - Street 1:209 E WILLIAM ST STE 104A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-4017
Practice Address - Country:US
Practice Address - Phone:316-613-6111
Practice Address - Fax:316-613-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty