Organization
KUPUNA ALTERNATIVE CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LEA D NORDLOH R.N., M.S.N. (RN CASE MANAGER, ADMINISTRATOR)
(808) 933-9229
Entity
Organization
Contact information
Practice address
350 LEHUA ST, HILO, HI 96720-2351
(808) 933-9229
(808) 933-1444
Mailing address
HC 2 BOX 6924, KEAAU, HI 96749-9336
(808) 933-9229
(808) 933-1444
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
30137544
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
566961
MEDICAID PROVIDER NUMBER
HI
Enumeration date
09/28/2006
Last updated
08/22/2020
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