Provider Demographics
NPI:1801680947
Name:MENTAL OASIS LLC
Entity type:Organization
Organization Name:MENTAL OASIS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:
Authorized Official - Last Name:C. RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-593-3853
Mailing Address - Street 1:6 W PARK AVE UNIT 1363
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-6257
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 W PARK AVE UNIT 1363
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-6257
Practice Address - Country:US
Practice Address - Phone:352-593-3853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-05
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)