Healthcare Provider Details

I. General information

NPI: 1568355451
Provider Name (Legal Business Name): EAGLES OASIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8754 E VIA DE ENCANTO
SCOTTSDALE AZ
85258-4019
US

IV. Provider business mailing address

1833 W LARK DR
CHANDLER AZ
85286-7485
US

V. Phone/Fax

Practice location:
  • Phone: 602-705-1011
  • Fax:
Mailing address:
  • Phone: 602-705-1011
  • Fax: 602-705-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MYRIO M DAVIS
Title or Position: CEO
Credential:
Phone: 602-705-1011