Provider Demographics
NPI:1811666985
Name:PUEO INSTITUTE OF HOLISTIC MEDICINE
Entity type:Organization
Organization Name:PUEO INSTITUTE OF HOLISTIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:MEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-640-2106
Mailing Address - Street 1:PO BOX 1615
Mailing Address - Street 2:
Mailing Address - City:KAPAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96755-1441
Mailing Address - Country:US
Mailing Address - Phone:808-640-2106
Mailing Address - Fax:
Practice Address - Street 1:54-2489 KYNNERSLEY ROAD
Practice Address - Street 2:LOT C
Practice Address - City:KAPAAU
Practice Address - State:HI
Practice Address - Zip Code:96755
Practice Address - Country:US
Practice Address - Phone:808-640-2106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SNRG ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities