# MARY JEAN B. URSUA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114253853
- **Authorized official:** MS. MARY JEAN BARBADO URSUA CAREGIVER (LPN)
- **Authorized official phone:** (808) 877-0351

## Contact information

- **Practice address:** 383 W PAPA AVE, KAHULUI, HI 96732-2639
- **Practice address phone:** (808) 877-0351
- **Practice address fax:** (808) 877-0351
- **Mailing address:** 383 W PAPA AVE, KAHULUI, HI 96732-2639
- **Mailing address phone:** (808) 877-0351
- **Mailing address fax:** (808) 877-0351

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | W03609234-01 | HI | Yes |

## Other

- **Enumeration date:** 11/01/2009
- **Last updated:** 11/01/2009