Provider Demographics
NPI:1003411273
Name:CULTURED CARE LLC
Entity Type:Organization
Organization Name:CULTURED CARE LLC
Other - Org Name:CULTURED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEFFANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACHE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:971-717-2307
Mailing Address - Street 1:6745 SW HAMPTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8360
Mailing Address - Country:US
Mailing Address - Phone:877-301-9077
Mailing Address - Fax:866-959-3177
Practice Address - Street 1:6745 SW HAMPTON ST STE 200
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8360
Practice Address - Country:US
Practice Address - Phone:877-301-9077
Practice Address - Fax:866-959-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty