MEDICARE: OASIS HOMECARE LLC

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1609580125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OASIS HOMECARE LLC

Provider Business Mailing Address
First Line	:	9319 W GLENROSA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-0820
Country	:	US
Telephone Number	:	207-891-0242
Fax Number	:

Provider Business Practice Location Address
First Line	:	9319 W GLENROSA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-0820
Country	:	US
Telephone Number	:	207-891-0242
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NINETTE NEZERWE
Credential	:
Telephone Number	:	207-891-0242

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	01/10/2023

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Directions to “OASIS HOMECARE LLC ” Practice Location

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