Healthcare Provider Details

I. General information

NPI: 1699782342
Provider Name (Legal Business Name): KAHALA SENIOR LIVING COMMUNITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4389 MALIA ST
HONOLULU HI
96821-1106
US

IV. Provider business mailing address

4389 MALIA ST
HONOLULU HI
96821-1106
US

V. Phone/Fax

Practice location:
  • Phone: 808-218-7000
  • Fax: 808-218-7043
Mailing address:
  • Phone: 808-218-7001
  • Fax: 808-356-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number71-N
License Number StateHI

VIII. Authorized Official

Name: MR. PATRICK J. DUARTE
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 808-218-7000