MEDICARE: PHOENIX OASIS RECOVERY HOMES INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1912711383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX OASIS RECOVERY HOMES INC.

Provider Business Mailing Address
First Line	:	2218 E POLK ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-3986
Country	:	US
Telephone Number	:	636-778-1515
Fax Number	:	480-621-7872

Provider Business Practice Location Address
First Line	:	3400 GRAND AVE STE 211
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-4507
Country	:	US
Telephone Number	:	636-778-1515
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	ANTHONY J PFEFFER
Credential	:
Telephone Number	:	602-686-7260

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	02/05/2025

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