MEDICARE: PUA KIELE ADULT FOSTER HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311Z00000X	Custodial Care Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205789062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUA KIELE ADULT FOSTER HOME LLC

Provider Business Mailing Address
First Line	:	2740 PIKAKE ST
Second Line	:
City	:	LIHUE
State	:	HI
Zip	:	96766-1645
Country	:	US
Telephone Number	:	808-639-9455
Fax Number	:	808-320-3448

Provider Business Practice Location Address
First Line	:	2740 PIKAKE ST
Second Line	:
City	:	LIHUE
State	:	HI
Zip	:	96766-1645
Country	:	US
Telephone Number	:	808-639-9455
Fax Number	:	808-320-3448

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	RONALD CACUYONG TARRIGA
Credential	:
Telephone Number	:	808-639-9455

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	02/19/2026

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