Provider Demographics
NPI:1922375211
Name:EREDULIN V JULIAN
Entity Type:Organization
Organization Name:EREDULIN V JULIAN
Other - Org Name:JULIAN'S ADULT FOSTER FAMILY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EREDULIN
Authorized Official - Middle Name:V
Authorized Official - Last Name:JULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-966-5450
Mailing Address - Street 1:17-202 IPUAIWAHA ST.
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749
Mailing Address - Country:US
Mailing Address - Phone:808-966-5450
Mailing Address - Fax:808-966-5450
Practice Address - Street 1:17-202 IPUAIWAHA ST
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-8229
Practice Address - Country:US
Practice Address - Phone:808-966-5450
Practice Address - Fax:808-966-5450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI531819311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
376K00000XOtherTAXONOMY CODE
HI531819Medicaid