Provider Demographics
NPI:1689164576
Name:KA LANI LLC
Entity Type:Organization
Organization Name:KA LANI LLC
Other - Org Name:KA LANI MASSAGE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LETLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-380-7174
Mailing Address - Street 1:13 MARCH FARM WAY UNIT C
Mailing Address - Street 2:
Mailing Address - City:GREENLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03840-6235
Mailing Address - Country:US
Mailing Address - Phone:603-380-7174
Mailing Address - Fax:
Practice Address - Street 1:13 MARCH FARM WAY UNIT C
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-6235
Practice Address - Country:US
Practice Address - Phone:603-380-7174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH=========OtherVA