Provider Demographics
NPI:1063005379
Name:TLC WELLNESS HAWAII, LLC
Entity type:Organization
Organization Name:TLC WELLNESS HAWAII, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSADELIMA
Authorized Official - Middle Name:YUTAN
Authorized Official - Last Name:ROSLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-800-7886
Mailing Address - Street 1:410 ATKINSON DR STE 462
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4730
Mailing Address - Country:US
Mailing Address - Phone:808-200-1776
Mailing Address - Fax:808-200-4013
Practice Address - Street 1:410 ATKINSON DR STE 462
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4730
Practice Address - Country:US
Practice Address - Phone:808-200-1776
Practice Address - Fax:808-200-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI818073Medicaid