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General NPI Number Information
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NPI Number | 1114463551
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Entity Type | Organization
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Legal Business Name | NAGOMI FOSTER HOMES
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 4475 WAHINEKOA PL
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City | HONOLULU
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State | HI
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Zip | 96821-1143
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Country | US
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Telephone | 808-398-4194
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Fax | 808-735-1706
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Provider Business Mailing Address
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Address Line | 4475 WAHINEKOA PL
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City | HONOLULU
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State | HI
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Zip | 96821-1143
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Country | US
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Telephone | 808-398-4194
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Fax | 808-735-1706
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAYOKO MIURA
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Credential |
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Telephone | 808-398-4194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 1-140018
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License Number State | HI
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