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General NPI Number Information
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NPI Number | 1386456317
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Entity Type | Organization
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Legal Business Name | EMPYREAN OASIS WELLNESS CENTER INC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 8401 MAYLAND DR STE 5259
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City | RICHMOND
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State | VA
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Zip | 23294-4648
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Country | US
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Telephone | 618-310-8306
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Fax |
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Provider Business Mailing Address
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Address Line | 8401 MAYLAND DR STE 5259
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City | RICHMOND
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State | VA
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Zip | 23294-4648
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Country | US
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Telephone | 618-310-8306
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. LATOYA PAULETTE
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Credential | LCSW
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Telephone | 323-506-9714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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