Provider Demographics
NPI:1932725835
Name:OASIS GROUP HOME LLC
Entity Type:Organization
Organization Name:OASIS GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENAVIDES
Authorized Official - Middle Name:EUSEBIO
Authorized Official - Last Name:TORRENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-516-4492
Mailing Address - Street 1:2206 W. SPUR DR.
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5752
Mailing Address - Country:US
Mailing Address - Phone:602-516-4492
Mailing Address - Fax:623-234-8284
Practice Address - Street 1:2206 W. SPUR DR.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-5752
Practice Address - Country:US
Practice Address - Phone:602-516-4492
Practice Address - Fax:623-234-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home