Provider Demographics
NPI:1730330614
Name:KONA ADULT DAY CENTER, INC.
Entity type:Organization
Organization Name:KONA ADULT DAY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROWENA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-322-7977
Mailing Address - Street 1:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-1360
Mailing Address - Country:US
Mailing Address - Phone:808-322-7922
Mailing Address - Fax:808-322-0614
Practice Address - Street 1:81989 HALEKII STREET
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750
Practice Address - Country:US
Practice Address - Phone:808-322-7977
Practice Address - Fax:808-322-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI385H00000X385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI518300Medicaid