Savannah Rose Wellness
Organization Active NPI Psychiatric/Mental Health Nurse Practitioner · Carolina Beach, NC
NPI 1093661795 · NPPES record last updated Jul 22, 2026
Key facts
- NPI
- 1093661795
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- Legal business name
- SAVANNAH ROSE WELLNESS
- Practice address
- 201 Lumberton Ave
Carolina Beach, NC 28428-4846 - Phone
- (910) 543-3558
- Fax
- (910) 400-2095
- NPI assigned
- Mar 6, 2026
- Organization subpart
- No
Authorized official
- Name
- Heather Black, DNP
- Title
- Owner
- Phone
- (910) 232-0140
Practitioners 1
-
Heather Black, DNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260609001548 | NC | Part B Supplier - Clinic/Group Practice | 1850862038 |
Receives reassigned benefits from 1 practitioner Practice locations: Carolina Beach, NC |
National Provider Directory
Locations
201 Lumberton Ave
Carolina Beach, NC 28428
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | Yes |
Addresses
Primary practice location
201 Lumberton Ave
Carolina Beach, NC 28428-4846
Mailing address
201 Lumberton Ave
Carolina Beach, NC 28428-4846
Phone (910) 543-3558
Other providers in Carolina Beach, NC
- Justine J. Reel
- Heather Reynolds
- Meghan Elizabeth Richardson
- Howard Ruscetti
- Jeanie Lynn Sadler
- Seaside Counseling Services, PLLC
- Seaside Internal Medicine PLLC
- Shoreview Medical Associates, PLLC
- Vincent Robert Smith
- Hannah Solum
All providers in Carolina Beach, NC · Psychiatric/Mental Health Nurse Practitioner in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.