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General NPI Number Information
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NPI Number | 1255336376
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Entity Type | Organization
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Legal Business Name | ISLAND NURSING HOME, INC.
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 1205 ALEXANDER ST
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City | HONOLULU
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State | HI
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Zip | 96826-1229
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Country | US
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Telephone | 808-946-5027
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Fax | 866-596-0130
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Provider Business Mailing Address
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Address Line | 1205 ALEXANDER ST
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City | HONOLULU
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State | HI
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Zip | 96826-1229
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Country | US
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Telephone | 808-946-5027
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Fax | 866-596-0130
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | MR. LELAND M YAGI
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Credential |
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Telephone | 808-946-5027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2-N
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License Number State | HI
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