{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "KUKUI NA KUPUNA, LLC",
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "970 N KALAHEO AVE",
"SecondLineMailingAddress": "SUITE C-200",
"MailingAddressCityName": "KAILUA",
"MailingAddressStateName": "HI",
"MailingAddressPostalCode": "96734-1866",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-744-0215",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "970 N KALAHEO AVE",
"SecondLinePracticeLocationAddress": "SUITE C-200",
"PracticeLocationAddressCityName": "KAILUA",
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"PracticeLocationAddressTelephoneNumber": "808-744-0215",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/21/2016",
"LastUpdateDate": "12/21/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MERIDETH",
"AuthorizedOfficialFirstName": "EDWIN",
"AuthorizedOfficialMiddleName": "LAWRENCE",
"AuthorizedOfficialTitle": "MANAGING OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": "MSHCM",
"AuthorizedOfficialTelephoneNumber": "808-546-0097",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "253Z00000X",
"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}