Healthcare Provider Details

I. General information

NPI: 1679458368
Provider Name (Legal Business Name): FERN ROOT WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 GLENDALE DR
FOREST CITY NC
28043-8738
US

IV. Provider business mailing address

121 GLENDALE DR
FOREST CITY NC
28043-8738
US

V. Phone/Fax

Practice location:
  • Phone: 828-467-9609
  • Fax:
Mailing address:
  • Phone: 828-467-9609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RACHAEL A HEALY
Title or Position: CEO
Credential:
Phone: 828-467-9609