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General NPI Number Information
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NPI Number | 1861812406
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Entity Type | Organization
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Legal Business Name | DELIA LAURENA ADULT RESIDENTIAL CARE HOME LLC
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 1654 HAUIKI ST
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City | HONOLULU
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State | HI
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Zip | 96819-2614
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Country | US
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Telephone | 808-845-9373
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Fax |
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Provider Business Mailing Address
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Address Line | 1654 HAUIKI ST
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City | HONOLULU
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State | HI
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Zip | 96819-2614
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DELIA LAURENA
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Credential |
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Telephone | 808-845-9373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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