Healthcare Provider Details

I. General information

NPI: 1093661795
Provider Name (Legal Business Name): SAVANNAH ROSE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LUMBERTON AVE
CAROLINA BEACH NC
28428-4846
US

IV. Provider business mailing address

201 LUMBERTON AVE
CAROLINA BEACH NC
28428-4846
US

V. Phone/Fax

Practice location:
  • Phone: 910-543-3558
  • Fax: 910-400-2095
Mailing address:
  • Phone: 910-543-3558
  • Fax: 910-400-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HEATHER BLACK
Title or Position: OWNER
Credential: DNP
Phone: 910-232-0140