Provider Demographics
NPI:1174921472
Name:RECOVERY OASIS LLC
Entity type:Organization
Organization Name:RECOVERY OASIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:VERNE
Authorized Official - Last Name:MULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:480-699-1233
Mailing Address - Street 1:1208 E BROADWAY RD STE 215
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1512
Mailing Address - Country:US
Mailing Address - Phone:480-699-1233
Mailing Address - Fax:480-907-7082
Practice Address - Street 1:1208 E BROADWAY RD STE 215
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1512
Practice Address - Country:US
Practice Address - Phone:480-699-1233
Practice Address - Fax:480-907-7082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ268132Medicaid