MEDICARE: KULEANA CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1437861770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KULEANA CARE

Provider Business Mailing Address
First Line	:	21538 N 58TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85054-5729
Country	:	US
Telephone Number	:	951-751-4576
Fax Number	:

Provider Business Practice Location Address
First Line	:	4733 W HATCHER RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-3625
Country	:	US
Telephone Number	:	951-751-4576
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	CODY VICAIRO
Credential	:
Telephone Number	:	951-751-4576

Provider Enumeration Date	:	12/19/2022
Last Update Date	:	12/19/2022

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Directions to “KULEANA CARE ” Practice Location

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