Healthcare Provider Details

I. General information

NPI: 1336315068
Provider Name (Legal Business Name): OAHU SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53-594 KAMEHAMEHA HWY
HAUULA HI
96717-9648
US

IV. Provider business mailing address

3723 FAIRVIEW INDUSTRIAL DR SE
SALEM OR
97302-1177
US

V. Phone/Fax

Practice location:
  • Phone: 808-293-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateHI

VIII. Authorized Official

Name: JON HARDER
Title or Position: MANAGER
Credential:
Phone: 503-375-9016