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General NPI Number Information
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NPI Number | 1194479105
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Entity Type | Organization
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Legal Business Name | KAUAI HOME CARE LLC
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 4-831 KUHIO HWY STE 372-A
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City | KAPAA
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State | HI
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Zip | 96746-1578
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Country | US
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Telephone | 808-651-1899
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1142
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City | KILAUEA
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State | HI
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Zip | 96754-1142
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Country | US
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Telephone | 808-651-1899
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JUDIAH MCROBERTS
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Credential |
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Telephone | 808-651-1899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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