Healthcare Provider Details

I. General information

NPI: 1134051782
Provider Name (Legal Business Name): LUNALILO HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 KEKAULUOHI ST
HONOLULU HI
96825-2399
US

IV. Provider business mailing address

501 KEKAULUOHI ST
HONOLULU HI
96825-2399
US

V. Phone/Fax

Practice location:
  • Phone: 808-395-1000
  • Fax: 808-395-8487
Mailing address:
  • Phone: 808-395-1000
  • Fax: 808-395-8487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSIE DEAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 808-395-1000