MEDICARE: PNW KUPUNA CARE, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1477163236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PNW KUPUNA CARE, LLC

Provider Business Mailing Address
First Line	:	203 S 4TH AVE
Second Line	:
City	:	SEQUIM
State	:	WA
Zip	:	98382-3719
Country	:	US
Telephone Number	:	808-256-2179
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 S 4TH AVE
Second Line	:
City	:	SEQUIM
State	:	WA
Zip	:	98382-3719
Country	:	US
Telephone Number	:	808-756-8876
Fax Number	:

Authorized Official
Title or Position	:	CHEIF OPERATION OFFICER
Name	:	ISAAC ADAM SCHMIDT
Credential	:
Telephone Number	:	808-256-2179

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	06/03/2026

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