Healthcare Provider Details

I. General information

NPI: 1306046602
Provider Name (Legal Business Name): CARERESOURCE HAWAII
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 09/21/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 IWILEI RD SUITE 660
HONOLULU HI
96817-5388
US

IV. Provider business mailing address

680 IWILEI RD SUITE 660
HONOLULU HI
96817-5388
US

V. Phone/Fax

Practice location:
  • Phone: 808-534-4224
  • Fax: 808-531-2832
Mailing address:
  • Phone: 808-599-4999
  • Fax: 808-531-2832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA-16
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: THAD WAKASUGI
Title or Position: CONTROLLER
Credential:
Phone: 808-599-9999