Provider Demographics
NPI:1811533672
Name:CULTIVATE JOY NUTRITION, LLC
Entity type:Organization
Organization Name:CULTIVATE JOY NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RD AND OWNER OF CULTIVATE JOY NUTRI
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:CLODFELTER-MASON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:317-914-3049
Mailing Address - Street 1:2031 EAGLEBROOKE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-9396
Mailing Address - Country:US
Mailing Address - Phone:317-914-3049
Mailing Address - Fax:
Practice Address - Street 1:2031 EAGLEBROOKE PARKWAY
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-9396
Practice Address - Country:US
Practice Address - Phone:317-914-3049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty