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General NPI Number Information
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NPI Number | 1023373974
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Entity Type | Organization
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Legal Business Name | KOREAN CARE HOME
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 07/06/2012
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Provider Practice Location Address
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Address Line | 525 KIAPU PLACE KOREAN CARE HOME
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City | HONOLULU
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State | HI
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Zip | 96817
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Country | US
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Telephone | 808-533-3157
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Fax |
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Provider Business Mailing Address
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Address Line | 525 KIAPU PLACE KOREAN CARE HOME
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City | HONOLULU
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State | HI
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Zip | 96817
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Country | US
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Telephone | 808-533-3157
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SAMSIL CANNON
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Credential |
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Telephone | 808-533-3157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | OHCA#105-C
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License Number State | HI
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