Healthcare Provider Details

I. General information

NPI: 1043207202
Provider Name (Legal Business Name): ANN PEARL CARE HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-181 WAIKALUA RD
KANEOHE HI
96744-2765
US

IV. Provider business mailing address

45-181 WAIKALUA RD
KANEOHE HI
96744-2765
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-8558
  • Fax: 808-247-4115
Mailing address:
  • Phone: 808-247-8558
  • Fax: 808-247-4115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number57-N
License Number StateHI

VIII. Authorized Official

Name: RANDALL HATA
Title or Position: SECRETARY & TREASURER
Credential:
Phone: 808-247-0003