MEDICARE: MARY JANE A RITUMBAN ADULT FOSTER CARE

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1760719330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JANE A RITUMBAN ADULT FOSTER CARE

Provider Business Mailing Address
First Line	:	91-1062 AUHOLA ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3972
Country	:	US
Telephone Number	:	808-638-3119
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-1062 AUHOLA ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3972
Country	:	US
Telephone Number	:	808-638-3119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	11/03/2009

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