Provider Demographics
NPI:1619697281
Name:KOKUA HEALTHCARE
Entity Type:Organization
Organization Name:KOKUA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MAUER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:808-466-1863
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-0326
Mailing Address - Country:US
Mailing Address - Phone:808-466-1863
Mailing Address - Fax:808-900-3647
Practice Address - Street 1:3-3178 KUHIO HWY STE D2
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1172
Practice Address - Country:US
Practice Address - Phone:808-466-1863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care