# HEAVENLY OASIS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053766170
- **Authorized official:** MR. JEREMIAH REED M.T (MASSAGE THERAPIST)
- **Authorized official phone:** (318) 516-9626

## Contact information

- **Practice address:** 2107 HONOR ST, SUITE C, MONROE, LA 71201-3648
- **Practice address phone:** (318) 516-9626
- **Mailing address:** 2107 HONOR ST, SUITE C, MONROE, LA 71201-3648
- **Mailing address phone:** (318) 516-9626

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | LA5986 | LA | Yes |

## Other

- **Enumeration date:** 04/26/2016
- **Last updated:** 04/26/2016