Healthcare Provider Details

I. General information

NPI: 1144659020
Provider Name (Legal Business Name): NOVA LUNA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 LILIHUA PL
WAILUKU HI
96793-1313
US

IV. Provider business mailing address

16-643 KIPIMANA STREET SUITE 20 NOVA LUNA INC C/O MICROIMAGING
KEAAU HI
96749
US

V. Phone/Fax

Practice location:
  • Phone: 808-249-9999
  • Fax:
Mailing address:
  • Phone: 808-966-7453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number98-STF
License Number StateHI

VIII. Authorized Official

Name: CATHY MEYER-UYEHARA
Title or Position: CEO
Credential: FACHE
Phone: 808-386-5849