Healthcare Provider Details

I. General information

NPI: 1437861770
Provider Name (Legal Business Name): KULEANA CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 W HATCHER RD
GLENDALE AZ
85302-3625
US

IV. Provider business mailing address

21538 N 58TH ST
PHOENIX AZ
85054-5729
US

V. Phone/Fax

Practice location:
  • Phone: 951-751-4576
  • Fax:
Mailing address:
  • Phone: 951-751-4576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: CODY VICAIRO
Title or Position: OWNER/MANAGER
Credential:
Phone: 951-751-4576