MEDICARE: OASIS RECOVERY HOUSE, 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1679987499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OASIS RECOVERY HOUSE, LLC

Provider Business Mailing Address
First Line	:	3541 W VOGEL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-1262
Country	:	US
Telephone Number	:	602-574-3343
Fax Number	:

Provider Business Practice Location Address
First Line	:	9645 N 11TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-3066
Country	:	US
Telephone Number	:	602-299-7561
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIO OLVERA
Credential	:
Telephone Number	:	602-574-3343

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	06/19/2014

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