Provider Demographics
NPI:1083191027
Name:M & C FOSTER CARE HOME LLC
Entity Type:Organization
Organization Name:M & C FOSTER CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANANSALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-619-5836
Mailing Address - Street 1:3093 WOOLSEY PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1569
Mailing Address - Country:US
Mailing Address - Phone:509-619-5836
Mailing Address - Fax:808-988-6452
Practice Address - Street 1:3093 WOOLSEY PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1569
Practice Address - Country:US
Practice Address - Phone:509-619-5836
Practice Address - Fax:808-988-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility