Healthcare Provider Details

I. General information

NPI: 1639096738
Provider Name (Legal Business Name): EMPOWERING OASIS WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 E BIDDLE ST
BALTIMORE MD
21202-5628
US

IV. Provider business mailing address

2724 E MONUMENT ST
BALTIMORE MD
21205-2645
US

V. Phone/Fax

Practice location:
  • Phone: 443-925-8603
  • Fax:
Mailing address:
  • Phone: 443-925-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DENOLLA LASTER
Title or Position: CEO
Credential:
Phone: 443-925-8603