Provider Demographics
NPI:1033686654
Name:THE OASIS TREATMENT CENTER LLC
Entity type:Organization
Organization Name:THE OASIS TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-426-4447
Mailing Address - Street 1:6035 AIRLINE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4224
Mailing Address - Country:US
Mailing Address - Phone:832-338-7103
Mailing Address - Fax:
Practice Address - Street 1:6035 AIRLINE DR STE 3
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4224
Practice Address - Country:US
Practice Address - Phone:832-338-7103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE OASIS TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348809001Medicaid