Provider Demographics
NPI:1538569348
Name:MORIN, ILUMINADA (CNA; PBT(ASCP)CM)
Entity type:Individual
Prefix:
First Name:ILUMINADA
Middle Name:
Last Name:MORIN
Suffix:
Gender:F
Credentials:CNA; PBT(ASCP)CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-079 WAIKELE LOOP
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2641
Mailing Address - Country:US
Mailing Address - Phone:808-686-9399
Mailing Address - Fax:888-486-4191
Practice Address - Street 1:94-079 WAIKELE LOOP
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2641
Practice Address - Country:US
Practice Address - Phone:808-686-9399
Practice Address - Fax:888-486-4191
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHCBS 09-311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home