Provider Demographics
NPI:1225657307
Name:HEALING TIDES PRIMARY CARE LLC
Entity Type:Organization
Organization Name:HEALING TIDES PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-271-2619
Mailing Address - Street 1:1110 NUUANU AVE # A1-182
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5119
Mailing Address - Country:US
Mailing Address - Phone:808-271-2619
Mailing Address - Fax:
Practice Address - Street 1:1110 NUUANU AVE # A1-182
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5119
Practice Address - Country:US
Practice Address - Phone:808-271-2619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty