Provider Demographics
NPI:1053809467
Name:HAWAIIAN JELLYS, LLC.
Entity type:Organization
Organization Name:HAWAIIAN JELLYS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GERSTENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-697-0223
Mailing Address - Street 1:151 SUMMER ST UNIT 563
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-3420
Mailing Address - Country:US
Mailing Address - Phone:303-697-0223
Mailing Address - Fax:
Practice Address - Street 1:5477 TIGER BEND LN
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-9679
Practice Address - Country:US
Practice Address - Phone:303-697-0223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier