Organization Name: | MALAMA NA KEIKI O KAUAI, LLC |
NPI Number: | 1275987679 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES RAELSON (PRESIDENT) |
Mailing Address: | 2469 Puu Rd Ste C Kalaheo |
State: | HI US |
Postal Code: | 967418509 |
Phone Number: | 8086451286 |
Fax Number: | |
NPI Enumeration Date: | 04/21/2016 |
NPI Last Update Date: | 04/21/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 13598 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |