Provider Demographics
NPI:1437861770
Name:KULEANA CARE
Entity Type:Organization
Organization Name:KULEANA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:VICAIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-751-4576
Mailing Address - Street 1:21538 N 58TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5729
Mailing Address - Country:US
Mailing Address - Phone:951-751-4576
Mailing Address - Fax:
Practice Address - Street 1:4733 W HATCHER RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3625
Practice Address - Country:US
Practice Address - Phone:951-751-4576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty