Provider Demographics
NPI:1396213302
Name:AMAZING GRACE OASIS II
Entity type:Organization
Organization Name:AMAZING GRACE OASIS II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREASYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-572-3956
Mailing Address - Street 1:8708 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92344-5562
Mailing Address - Country:US
Mailing Address - Phone:818-572-3956
Mailing Address - Fax:818-925-3011
Practice Address - Street 1:8708 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92344-5562
Practice Address - Country:US
Practice Address - Phone:818-572-3956
Practice Address - Fax:818-925-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness