Provider Demographics
NPI:1962163402
Name:CULTIVATOR, INC.
Entity type:Organization
Organization Name:CULTIVATOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:FLEETWOOD
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-395-2327
Mailing Address - Street 1:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855-0704
Mailing Address - Country:US
Mailing Address - Phone:252-395-2327
Mailing Address - Fax:
Practice Address - Street 1:1228 EAST MAIN STREET
Practice Address - Street 2:US HWY 158 BUSINESS
Practice Address - City:MURFREESBORO
Practice Address - State:NC
Practice Address - Zip Code:27855
Practice Address - Country:US
Practice Address - Phone:252-395-2327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service