Provider Demographics
NPI:1205183472
Name:KUPUKUPU CENTER FOR ARTS AND HEALING LLC
Entity Type:Organization
Organization Name:KUPUKUPU CENTER FOR ARTS AND HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOERKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-965-6307
Mailing Address - Street 1:PO BOX 1864
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-1864
Mailing Address - Country:US
Mailing Address - Phone:808-965-6307
Mailing Address - Fax:
Practice Address - Street 1:15-2958 PAHOA VILLAGE RD
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778
Practice Address - Country:US
Practice Address - Phone:808-965-6307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty