Healthcare Provider Details

I. General information

NPI: 1407270028
Provider Name (Legal Business Name): LUCAS, MELANIE G
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-272 PUPUKOAE ST
WAIPAHU HI
96797-2610
US

IV. Provider business mailing address

94-272 PUPUKOAE ST
WAIPAHU HI
96797-2610
US

V. Phone/Fax

Practice location:
  • Phone: 808-678-8248
  • Fax:
Mailing address:
  • Phone: 808-678-8248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MELANIE LUCAS
Title or Position: OWNER
Credential:
Phone: 808-678-8248