Provider Demographics
NPI:1831857945
Name:OASIS OF HOPE THERAPY LLC
Entity type:Organization
Organization Name:OASIS OF HOPE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:386-697-8842
Mailing Address - Street 1:PO BOX 3394
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-3394
Mailing Address - Country:US
Mailing Address - Phone:386-697-8842
Mailing Address - Fax:
Practice Address - Street 1:260 S MARION AVE STE 135
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-7000
Practice Address - Country:US
Practice Address - Phone:386-697-8842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116149000Medicaid