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General NPI Number Information
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NPI Number | 1922375211
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Entity Type | Organization
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Legal Business Name | EREDULIN V JULIAN
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 17-202 IPUAIWAHA ST
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City | KEAAU
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State | HI
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Zip | 96749-8229
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Country | US
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Telephone | 808-966-5450
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Fax | 808-966-5450
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Provider Business Mailing Address
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Address Line | 17-202 IPUAIWAHA ST.
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City | KEAAU
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State | HI
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Zip | 96749
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Country | US
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Telephone | 808-966-5450
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Fax | 808-966-5450
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Authorized Official
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Title or Position | OWNER
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Name | MRS. EREDULIN V JULIAN
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Credential |
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Telephone | 808-966-5450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 531819
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License Number State | HI
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