Healthcare Provider Details

I. General information

NPI: 1689045163
Provider Name (Legal Business Name): DESERT OASIS RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PAISANO ST NE
ALBUQUERQUE NM
87123-1453
US

IV. Provider business mailing address

600 PAISANO ST NE
ALBUQUERQUE NM
87123-1453
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-8184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW SIDOLI
Title or Position: COO
Credential:
Phone: 505-504-0260