Healthcare Provider Details

I. General information

NPI: 1013196344
Provider Name (Legal Business Name): MBSB HUALALAI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-181 HUALALAI RD
KAILUA KONA HI
96740-1787
US

IV. Provider business mailing address

3326 160TH AVE SE STE 120
BELLEVUE WA
98008-6418
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-7878
  • Fax:
Mailing address:
  • Phone: 425-392-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MARVIN BART BEDDOE
Title or Position: MANAGING MEMBER
Credential:
Phone: 425-392-4066