Provider Demographics
NPI:1104570233
Name:SOUTHERN OASIS BH, LLC
Entity type:Organization
Organization Name:SOUTHERN OASIS BH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASAHME
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, PMHNP-BC
Authorized Official - Phone:917-669-8305
Mailing Address - Street 1:156 ASTER CT
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889-2031
Mailing Address - Country:US
Mailing Address - Phone:176-698-3059
Mailing Address - Fax:
Practice Address - Street 1:401 W ATLANTIC AVE UNIT 127
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3689
Practice Address - Country:US
Practice Address - Phone:908-340-0492
Practice Address - Fax:732-734-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty