Healthcare Provider Details

I. General information

NPI: 1376525584
Provider Name (Legal Business Name): DIVERSIFIED MEDICAL ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BACHELOT ST
HONOLULU HI
96817-2431
US

IV. Provider business mailing address

1900 BACHELOT STREET
HONOLULU HI
96817-2431
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-5302
  • Fax: 808-538-3219
Mailing address:
  • Phone: 808-531-5302
  • Fax: 808-538-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number16N
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DENNIS GEORGE
Title or Position: VICE PRESIDENT
Credential:
Phone: 510-919-0618