Provider Demographics
NPI:1932860772
Name:SPIRIT ROSE WELLNESS LLC
Entity Type:Organization
Organization Name:SPIRIT ROSE WELLNESS LLC
Other - Org Name:PURITY ACUPUNCTURE & HOLISTIC WELLNESS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDGWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:828-242-2489
Mailing Address - Street 1:219 GREENVILLE AVE UNIT 203
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-1067
Mailing Address - Country:US
Mailing Address - Phone:828-242-2489
Mailing Address - Fax:
Practice Address - Street 1:138 CHARLOTTE ST UNIT 212
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1981
Practice Address - Country:US
Practice Address - Phone:828-242-2489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center