MEDICARE: OASIS RECOVERY HOME 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	:	1508702713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OASIS RECOVERY HOME LLC

Provider Business Mailing Address
First Line	:	4023 WEYBRIDGE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4847
Country	:	US
Telephone Number	:	702-416-4196
Fax Number	:

Provider Business Practice Location Address
First Line	:	4299 CARTEGENA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6501
Country	:	US
Telephone Number	:	702-416-4196
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT WALCOM
Credential	:
Telephone Number	:	702-416-4196

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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