Healthcare Provider Details

I. General information

NPI: 1649697327
Provider Name (Legal Business Name): KUPUNA CARE HAWAII LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 12/22/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 ELM ST
HONOLULU HI
96814-2224
US

IV. Provider business mailing address

1144 ELM ST
HONOLULU HI
96814-2224
US

V. Phone/Fax

Practice location:
  • Phone: 808-202-2012
  • Fax:
Mailing address:
  • Phone: 808-202-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DIANA CABALLERO
Title or Position: PRESIDENT
Credential: RN, BSN
Phone: 808-202-2012