Healthcare Provider Details

I. General information

NPI: 1093529174
Provider Name (Legal Business Name): CAGES TO WINGS WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/09/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 WAOLANI AVE
HONOLULU HI
96817-1361
US

IV. Provider business mailing address

PO BOX 235192
HONOLULU HI
96823-3503
US

V. Phone/Fax

Practice location:
  • Phone: 808-480-4198
  • Fax:
Mailing address:
  • Phone: 808-480-4198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JETHRO TANGONAN MACARAEG
Title or Position: OWNER
Credential: LCSW
Phone: 808-480-4198