Healthcare Provider Details

I. General information

NPI: 1447782123
Provider Name (Legal Business Name): NA PU'UWAI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 MAUNALOA HWY
KAUNAKAKAI HI
96748
US

IV. Provider business mailing address

PO BOX 130
KAUNAKAKAI HI
96748-0130
US

V. Phone/Fax

Practice location:
  • Phone: 808-560-3653
  • Fax: 808-560-3385
Mailing address:
  • Phone: 808-560-3653
  • Fax: 808-560-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADHC-9
License Number StateHI

VIII. Authorized Official

Name: DAPHNE FARRAR LAW
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 808-560-3653