Provider Demographics
NPI:1972052454
Name:JLJAG ADULT DAY CARE CENTER
Entity type:Organization
Organization Name:JLJAG ADULT DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LILY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-397-9084
Mailing Address - Street 1:92-1359 HUNEKAI ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1518
Mailing Address - Country:US
Mailing Address - Phone:808-397-9084
Mailing Address - Fax:808-672-3092
Practice Address - Street 1:92-1359 HUNEKAI ST
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1518
Practice Address - Country:US
Practice Address - Phone:808-397-9084
Practice Address - Fax:808-672-3092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)