Provider Demographics
NPI:1073069134
Name:MANILYN B NAGTALON
Entity Type:Organization
Organization Name:MANILYN B NAGTALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAREGIVER
Authorized Official - Prefix:
Authorized Official - First Name:MANILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGTALON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-744-6396
Mailing Address - Street 1:91-1002 FORT WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2229
Mailing Address - Country:US
Mailing Address - Phone:808-744-6396
Mailing Address - Fax:808-744-6396
Practice Address - Street 1:91-1002 FORT WEAVER RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2229
Practice Address - Country:US
Practice Address - Phone:808-744-6396
Practice Address - Fax:808-744-6396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW48371325-01313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility