Provider Demographics
NPI:1194479105
Name:KAUAI HOME CARE LLC
Entity type:Organization
Organization Name:KAUAI HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUDIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-651-1899
Mailing Address - Street 1:PO BOX 1142
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-1142
Mailing Address - Country:US
Mailing Address - Phone:808-651-1899
Mailing Address - Fax:
Practice Address - Street 1:4-831 KUHIO HWY STE 372-A
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1578
Practice Address - Country:US
Practice Address - Phone:808-651-1899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health