Provider Demographics
NPI:1376967802
Name:HUA MOON WOMEN'S HEALTH LLC
Entity Type:Organization
Organization Name:HUA MOON WOMEN'S HEALTH LLC
Other - Org Name:HOME BIRTH KAUAI LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLETTE
Authorized Official - Middle Name:GERMAINE
Authorized Official - Last Name:AGUINALDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-651-6341
Mailing Address - Street 1:4-1558 KUHIO HWY
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1856
Mailing Address - Country:US
Mailing Address - Phone:808-639-9722
Mailing Address - Fax:866-423-3332
Practice Address - Street 1:4-1558 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1856
Practice Address - Country:US
Practice Address - Phone:808-639-9722
Practice Address - Fax:866-423-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI176B00000X163W00000X, 163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, AmbulatoryGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI64868601Medicaid
HI00C0051296OtherHMSA
HIN772727OtherOHANA CARE MEDICAID