Provider Demographics
NPI:1255560314
Name:CULTURATION INC.
Entity type:Organization
Organization Name:CULTURATION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHETONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-574-1857
Mailing Address - Street 1:4144 THOMAS PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8942
Mailing Address - Country:US
Mailing Address - Phone:702-487-3095
Mailing Address - Fax:702-647-3714
Practice Address - Street 1:4144 THOMAS PATRICK AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8942
Practice Address - Country:US
Practice Address - Phone:702-487-3095
Practice Address - Fax:702-647-3714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children