Healthcare Provider Details

I. General information

NPI: 1609098144
Provider Name (Legal Business Name): LUNALILO HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 KEKAULUOHI STREET
HONOLULU HI
96825
US

IV. Provider business mailing address

501 KEKAULUOHI STREET
HONOLULU HI
96825
US

V. Phone/Fax

Practice location:
  • Phone: 808-394-1464
  • Fax: 808-395-8487
Mailing address:
  • Phone: 808-394-1464
  • Fax: 808-395-8487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number1295-C
License Number StateHI

VIII. Authorized Official

Name: GRACE MEE
Title or Position: FINANCE MANAGER
Credential:
Phone: 808-394-1464