Provider Demographics
NPI:1104915164
Name:OASIS REHABILITATION CENTER INC.
Entity type:Organization
Organization Name:OASIS REHABILITATION CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-221-6336
Mailing Address - Street 1:81840 AVE. 46
Mailing Address - Street 2:SUITE 201
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3948
Mailing Address - Country:US
Mailing Address - Phone:760-347-0750
Mailing Address - Fax:760-863-8603
Practice Address - Street 1:81840 AVE. 46
Practice Address - Street 2:SUITE 201
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3948
Practice Address - Country:US
Practice Address - Phone:760-347-0750
Practice Address - Fax:760-863-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA07-03013OtherCITY OF INDIO, BUSINESS
CA33DV01OtherSTATE DMH REPORTING #
CA33DVOtherDMH MEDICAL PROVIDER
CA2016025OtherSTATE DMH LICENSE NUMBER
CA2213893OtherSTATE CORP #