Healthcare Provider Details

I. General information

NPI: 1720442346
Provider Name (Legal Business Name): DALY RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 04/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LINO PL
MAKAWAO HI
96768-8545
US

IV. Provider business mailing address

820 KUPULAU DR
KIHEI HI
96753-9231
US

V. Phone/Fax

Practice location:
  • Phone: 808-280-2077
  • Fax: 888-501-5657
Mailing address:
  • Phone: 808-575-7677
  • Fax: 888-501-5657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number21789
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number645843
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number00040004
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MERRILY DIVINE DALY
Title or Position: PRESIDENT
Credential: CPM, RN, CLC, CLNC
Phone: 808-280-2077