Healthcare Provider Details

I. General information

NPI: 1114159449
Provider Name (Legal Business Name): DLMC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 09/19/2020
Certification Date: 09/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-023 HEKAHA STREET BUILDING 1 UNIT 209
AIEA HI
96701
US

IV. Provider business mailing address

PO BOX 1238
AIEA HI
96701-1238
US

V. Phone/Fax

Practice location:
  • Phone: 808-422-2802
  • Fax: 808-484-9076
Mailing address:
  • Phone: 808-422-2802
  • Fax: 808-484-9076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number27453540-01
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS LETICIA FAJARDO DEXTER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RN
Phone: 808-989-7882