Provider Demographics
NPI:1952039794
Name:GRACEFUL STRIDES WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:GRACEFUL STRIDES WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW
Authorized Official - Phone:218-626-5175
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:30 NORTH 8TH ST.
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720
Mailing Address - Country:US
Mailing Address - Phone:218-626-5175
Mailing Address - Fax:218-879-2696
Practice Address - Street 1:30 NORTH 8TH ST.
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720
Practice Address - Country:US
Practice Address - Phone:218-626-5175
Practice Address - Fax:218-879-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)