Provider Demographics
NPI:1932557766
Name:THE LAUNCH PAD WELLNESS, LLC
Entity Type:Organization
Organization Name:THE LAUNCH PAD WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE
Authorized Official - Prefix:
Authorized Official - First Name:LORALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-769-9048
Mailing Address - Street 1:3121 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1105 MERCHANT LN
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-4716
Practice Address - Country:US
Practice Address - Phone:910-769-6053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty