Provider Demographics
NPI:1538735055
Name:CULTIVATED TOUCHES LLC
Entity type:Organization
Organization Name:CULTIVATED TOUCHES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MOBILE PHLEBOTOMIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMISHA
Authorized Official - Middle Name:LAVETTE
Authorized Official - Last Name:PETERKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-578-7552
Mailing Address - Street 1:4922 BEAUREGARD ST APT 101
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-4959
Mailing Address - Country:US
Mailing Address - Phone:124-035-5993
Mailing Address - Fax:
Practice Address - Street 1:4922 BEAUREGARD ST APT 101
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-4959
Practice Address - Country:US
Practice Address - Phone:124-035-5993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care