Healthcare Provider Details

I. General information

NPI: 1235638487
Provider Name (Legal Business Name): HUAPALA SENIOR CARE B, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649B HUAPALA ST
HONOLULU HI
96822-1653
US

IV. Provider business mailing address

918 12TH AVE STE 1000
HONOLULU HI
96816-2251
US

V. Phone/Fax

Practice location:
  • Phone: 808-440-0560
  • Fax:
Mailing address:
  • Phone: 808-440-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number1527-C
License Number StateHI

VIII. Authorized Official

Name: PAUL M. DOLD
Title or Position: MANAGER
Credential:
Phone: 808-440-0560