Provider Demographics
NPI:1285939850
Name:ANNES OASIS LLC
Entity type:Organization
Organization Name:ANNES OASIS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:RADVANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-423-3838
Mailing Address - Street 1:7090 WILSON MILLS RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-1733
Mailing Address - Country:US
Mailing Address - Phone:440-423-3838
Mailing Address - Fax:440-423-0383
Practice Address - Street 1:7090 WILSON MILLS RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-1733
Practice Address - Country:US
Practice Address - Phone:440-423-3838
Practice Address - Fax:440-423-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1090AGH310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility