Provider Demographics
NPI:1609098144
Name:LUNALILO HOME
Entity Type:Organization
Organization Name:LUNALILO HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-394-1464
Mailing Address - Street 1:501 KEKAULUOHI STREET
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825
Mailing Address - Country:US
Mailing Address - Phone:808-394-1464
Mailing Address - Fax:808-395-8487
Practice Address - Street 1:501 KEKAULUOHI STREET
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825
Practice Address - Country:US
Practice Address - Phone:808-394-1464
Practice Address - Fax:808-395-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1295-C311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI583478-01Medicaid