=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639908502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KOKUA HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2024
-----------------------------------------------------
Last Update Date | 07/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3-3178 KUHIO HWY STE D2
-----------------------------------------------------
City | LIHUE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96766-1172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-466-1863
-----------------------------------------------------
Fax | 808-900-3647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 326
-----------------------------------------------------
City | KALAHEO
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96741-0326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-466-1863
-----------------------------------------------------
Fax | 808-900-3647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JACOB RUSSELL MAUER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-466-1863
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------