Healthcare Provider Details

I. General information

NPI: 1255336376
Provider Name (Legal Business Name): ISLAND NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 ALEXANDER ST
HONOLULU HI
96826-1229
US

IV. Provider business mailing address

1205 ALEXANDER ST
HONOLULU HI
96826-1229
US

V. Phone/Fax

Practice location:
  • Phone: 808-946-5027
  • Fax: 866-596-0130
Mailing address:
  • Phone: 808-946-5027
  • Fax: 866-596-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2-N
License Number StateHI

VIII. Authorized Official

Name: MR. LELAND M YAGI
Title or Position: PRESIDENT/ADMINISTRATOR
Credential:
Phone: 808-946-5027