Healthcare Provider Details

I. General information

NPI: 1154325405
Provider Name (Legal Business Name): KUAKINI GERIATRIC CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 N KUAKINI ST
HONOLULU HI
96817-2306
US

IV. Provider business mailing address

347 N KUAKINI ST
HONOLULU HI
96817-2306
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-2236
  • Fax:
Mailing address:
  • Phone: 808-547-9231
  • Fax: 808-547-9547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number25-N
License Number StateHI

VIII. Authorized Official

Name: MR. GARY K KAJIWARA
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 808-547-9231