Healthcare Provider Details

I. General information

NPI: 1497987879
Provider Name (Legal Business Name): TRADEWINDS AT THE PONDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
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

53-594 KAMEHAMEHA HWY
HAUULA HI
96717-9648
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 State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH L ROBERTSON
Title or Position: MANAGER
Credential:
Phone: 503-580-6925