Healthcare Provider Details

I. General information

NPI: 1336807791
Provider Name (Legal Business Name): TASS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 W PUAINAKO ST
HILO HI
96720-5366
US

IV. Provider business mailing address

137 W PUAINAKO ST
HILO HI
96720-5366
US

V. Phone/Fax

Practice location:
  • Phone: 808-909-2099
  • Fax: 808-900-7199
Mailing address:
  • Phone: 808-909-2099
  • Fax: 808-900-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health 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: DR. SHAWON SYED MUJIBOR RAHMAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 808-909-2099