Provider Demographics
NPI:1396808499
Name:OAS, LLC
Entity type:Organization
Organization Name:OAS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-222-5201
Mailing Address - Street 1:23 UPPER PLN
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033-9016
Mailing Address - Country:US
Mailing Address - Phone:802-222-5201
Mailing Address - Fax:802-222-5901
Practice Address - Street 1:23 UPPER PLN
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033-9016
Practice Address - Country:US
Practice Address - Phone:802-222-5201
Practice Address - Fax:802-222-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0540324500000X
VT3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Not Answered3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010872Medicaid