Healthcare Provider Details

I. General information

NPI: 1194701243
Provider Name (Legal Business Name): TOTAL HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 MOOWAA ST STE F
HONOLULU HI
96817-4428
US

IV. Provider business mailing address

4473 PAHEE ST SUITE I
LIHUE HI
96766-2037
US

V. Phone/Fax

Practice location:
  • Phone: 808-848-5197
  • Fax: 808-842-1552
Mailing address:
  • Phone: 808-848-5197
  • Fax: 808-842-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberW2056705401
License Number StateHI

VIII. Authorized Official

Name: KEVIN GLICK
Title or Position: PRESIDENT
Credential: RPH
Phone: 808-245-1864