Provider Demographics
NPI:1548449366
Name:CULVER, BETTY MARIA
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:MARIA
Last Name:CULVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7309 HUNT VALLEY TRAIL
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591
Mailing Address - Country:US
Mailing Address - Phone:919-365-4690
Mailing Address - Fax:919-366-9303
Practice Address - Street 1:7309 HUNT VALLEY TRAIL
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591
Practice Address - Country:US
Practice Address - Phone:919-365-4690
Practice Address - Fax:919-366-9303
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL092050311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802787Medicaid