Healthcare Provider Details

I. General information

NPI: 1619157922
Provider Name (Legal Business Name): PALOLO CHINESE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 10TH AVE
HONOLULU HI
96816-3051
US

IV. Provider business mailing address

2459 10TH AVE
HONOLULU HI
96816-3051
US

V. Phone/Fax

Practice location:
  • Phone: 808-737-2555
  • Fax: 808-735-1754
Mailing address:
  • Phone: 808-737-2555
  • Fax: 808-735-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number70-N
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number70-N
License Number StateHI

VIII. Authorized Official

Name: MRS. DARLENE NAKAYAMA
Title or Position: CEO
Credential:
Phone: 808-748-4901