Provider Demographics
NPI:1407684798
Name:OASIS HAVEN OF HEALING LLC
Entity type:Organization
Organization Name:OASIS HAVEN OF HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-358-2107
Mailing Address - Street 1:4207 BAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2560
Mailing Address - Country:US
Mailing Address - Phone:919-358-2107
Mailing Address - Fax:
Practice Address - Street 1:620 MORGAN SUMMERS RD.
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:NC
Practice Address - Zip Code:27342
Practice Address - Country:US
Practice Address - Phone:336-365-6765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)