Organization Name: | THE LAUNCH PAD WELLNESS, LLC |
NPI Number: | 1932557766 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LORALIE GRIGAS (ADMINISTRATIVE) |
Mailing Address: | 1105 Merchant Ln Carolina Beach |
State: | NC US |
Postal Code: | 284284716 |
Phone Number: | 9107696053 |
Fax Number: | |
NPI Enumeration Date: | 06/02/2016 |
NPI Last Update Date: | 06/02/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |