Healthcare Provider Details

I. General information

NPI: 1992228431
Provider Name (Legal Business Name): MALOHA GROUP, CORP. DBA ISLAND PACIFIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-210 PUPUKAHI ST STE 204
WAIPAHU HI
96797-2649
US

IV. Provider business mailing address

PO BOX 894824
MILILANI HI
96789-8331
US

V. Phone/Fax

Practice location:
  • Phone: 808-762-7507
  • Fax: 808-762-7508
Mailing address:
  • Phone: 808-762-7507
  • Fax: 808-762-7508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberGE-072-517-0176-01
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGELICA CONSULTA
Title or Position: PRESIDENT
Credential:
Phone: 808-762-7507