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General NPI Number Information
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NPI Number | 1689618308
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Entity Type | Organization
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Legal Business Name | KAUAI CARE CENTER, LLC
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 9611 WAENA ROAD
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City | KAUAI
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State | HI
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Zip | 96796
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Country | US
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Telephone | 808-338-1681
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Fax | 808-338-1297
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Provider Business Mailing Address
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Address Line | 3326 160TH AVE SE
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City | BELLEVUE
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State | WA
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Zip | 98008-6418
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Country | US
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Telephone | 425-392-4066
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Fax | 425-623-1517
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Authorized Official
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Title or Position | CEO
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Name | MARVIN BEDDOE
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Credential |
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Telephone | 425-392-4066
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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