| Organization Name: | OASIS RESIDENTIAL HOME |
| NPI Number: | 1881892651 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MAZIE GRAHAM (ADMINISTRATOR) |
| Mailing Address: | 2317 Prince St Georgetown |
| State: | SC US |
| Postal Code: | 294402925 |
| Phone Number: | 8435274848 |
| Fax Number: | |
| NPI Enumeration Date: | 07/03/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | CRC1219 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |