Provider Demographics
NPI:1336993971
Name:CULTIVATE MENTAL HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:CULTIVATE MENTAL HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:BURFORD
Authorized Official - Last Name:HATCH-PIGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-854-7028
Mailing Address - Street 1:76-6225 KUAKINI HWY STE C101
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3212
Mailing Address - Country:US
Mailing Address - Phone:808-329-7067
Mailing Address - Fax:808-329-2404
Practice Address - Street 1:76-6225 KUAKINI HWY STE C101
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3212
Practice Address - Country:US
Practice Address - Phone:808-329-7067
Practice Address - Fax:808-329-2404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA HATCH-PIGOTT, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health