Provider Demographics
NPI:1437811288
Name:LFR KAUAI LLC
Entity Type:Organization
Organization Name:LFR KAUAI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:FERNANDEZ
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:808-431-1101
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-0303
Mailing Address - Country:US
Mailing Address - Phone:808-431-1101
Mailing Address - Fax:
Practice Address - Street 1:2843 KANANI ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1626
Practice Address - Country:US
Practice Address - Phone:808-431-1101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI810152Medicaid