Healthcare Provider Details

I. General information

NPI: 1144913260
Provider Name (Legal Business Name): CULTIVATING HUMANITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 S PLAZA TRL STE 103
VIRGINIA BEACH VA
23452-3370
US

IV. Provider business mailing address

3529 CAMPION AVE
VIRGINIA BEACH VA
23462-6920
US

V. Phone/Fax

Practice location:
  • Phone: 757-717-0139
  • Fax:
Mailing address:
  • Phone: 757-717-0139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY HODGES
Title or Position: CEO
Credential:
Phone: 757-717-0139