Healthcare Provider Details

I. General information

NPI: 1205183472
Provider Name (Legal Business Name): KUPUKUPU CENTER FOR ARTS AND HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-2958 PAHOA VILLAGE RD
PAHOA HI
96778
US

IV. Provider business mailing address

PO BOX 1864
PAHOA HI
96778-1864
US

V. Phone/Fax

Practice location:
  • Phone: 808-965-6307
  • Fax:
Mailing address:
  • Phone: 808-965-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE JOERKE
Title or Position: LICENSED MASSAGE THERAPIST
Credential: L.M.T.
Phone: 808-965-6307