MEDICARE: OASIS ASSISTED LIVING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)	ALC-5167	AZ
2	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	ALC-5167	AZ
3	310400000X	Assisted Living Facility	ALC-5167	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	938392	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1205013356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OASIS ASSISTED LIVING CENTER

Provider Business Mailing Address
First Line	:	2721 N ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-4315
Country	:	US
Telephone Number	:	520-624-1771
Fax Number	:	520-629-1902

Provider Business Practice Location Address
First Line	:	2721 N ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-4315
Country	:	US
Telephone Number	:	520-624-1771
Fax Number	:	520-629-1902

Authorized Official
Title or Position	:	OWNER
Name	:	MR. TAD DENTON
Credential	:
Telephone Number	:	520-624-1771

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	01/30/2008

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Directions to “OASIS ASSISTED LIVING CENTER ” Practice Location

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