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General NPI Number Information
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NPI Number | 1659658664
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Entity Type | Organization
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Legal Business Name | CRAIGSIDE RETIREMENT RESIDENCE
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 15 CRAIGSIDE PL
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City | HONOLULU
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State | HI
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Zip | 96817-1799
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Country | US
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Telephone | 808-523-7000
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Fax | 808-533-5497
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Provider Business Mailing Address
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Address Line | 15 CRAIGSIDE PL
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City | HONOLULU
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State | HI
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Zip | 96817-1799
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Country | US
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Telephone | 808-523-7000
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Fax | 808-440-0026
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. EMMET WHITE
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Credential |
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Telephone | 808-983-1823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 79-N
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License Number State | HI
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