Provider Demographics
NPI:1336579077
Name:GROWTH AND WELLNESS CENTER, LLC.
Entity Type:Organization
Organization Name:GROWTH AND WELLNESS CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,
Authorized Official - Phone:704-927-5885
Mailing Address - Street 1:12001 OLYMPIC CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4057
Mailing Address - Country:US
Mailing Address - Phone:704-708-4605
Mailing Address - Fax:
Practice Address - Street 1:12001 OLYMPIC CLUB DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4057
Practice Address - Country:US
Practice Address - Phone:704-708-4605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness