Healthcare Provider Details

I. General information

NPI: 1124026901
Provider Name (Legal Business Name): ISLAND HEALTH CARE LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-545 KAMEHAMEHA HWY
KANEOHE HI
96744-1943
US

IV. Provider business mailing address

45-545 KAMEHAMEHA HWY
KANEOHE HI
96744-1943
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-2220
  • Fax: 808-235-3676
Mailing address:
  • Phone: 808-247-2220
  • Fax: 808-235-3676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number28-N
License Number StateHI

VIII. Authorized Official

Name: MR. CHARLES P HARRIS III
Title or Position: EXECUTIVE DIRECTOR
Credential: NHA
Phone: 808-247-2220