Organization
PRIME OASIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA ROSETTA WILSON (CHIEF EXECUTIVE OFFICER)
(703) 915-9526
Entity
Organization
Contact information
Practice address
619 E POYTHRESS ST, HOPEWELL, VA 23860-3106
(703) 915-9526
(240) 595-6187
Mailing address
PO BOX 1473, HOPEWELL, VA 23860-1473
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/02/2015
Last updated
04/02/2015
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