Provider Demographics
NPI:1396512729
Name:OASIS WELLNESS CENTER LLC
Entity type:Organization
Organization Name:OASIS WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOLAPO
Authorized Official - Middle Name:FUNMILAYO
Authorized Official - Last Name:OPEBIYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-515-3540
Mailing Address - Street 1:4709 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-3261
Mailing Address - Country:US
Mailing Address - Phone:617-515-3540
Mailing Address - Fax:
Practice Address - Street 1:4709 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-3261
Practice Address - Country:US
Practice Address - Phone:617-515-3540
Practice Address - Fax:617-553-7963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty