Organization
FALL FORWARD WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DENISE MELENDEZ (BUSINESS DEVELOPMENT MANAGER)
(954) 857-8479
Entity
Organization
Contact information
Practice address
12709 CALDWELL RD, CHARLOTTE, NC 28213-3811
(704) 968-2466
Mailing address
12709 CALDWELL RD, CHARLOTTE, NC 28213-3811
(704) 968-2466
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCAS-20838
NORTH CAROLINA PROFESSIONAL PRACTICE BOARD
NC
Enumeration date
06/23/2020
Last updated
06/23/2020
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