Healthcare Provider Details

I. General information

NPI: 1083605836
Provider Name (Legal Business Name): LIFE CARE SERVICES OF HAWAII LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 KALAKAUA AVE SECOND FLOOR
HONOLULU HI
96826-1908
US

IV. Provider business mailing address

1314 KALAKAUA AVE, 2ND FLOOR
HONOLULU HI
96826-1908
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-4444
  • Fax: 808-983-4499
Mailing address:
  • Phone: 808-893-4444
  • Fax: 808-983-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberOHCA-55-N
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number55-N
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOHCA#55-N
License Number StateHI

VIII. Authorized Official

Name: JILL I SORENSON
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 515-875-4500