1093074395 NPI number — MANOA ELDER CARE, L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093074395 NPI number — MANOA ELDER CARE, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANOA ELDER CARE, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MANOA SENIOR CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093074395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
918 12TH AVE
Provider Second Line Business Mailing Address:
SUITE1000
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96816-2251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-440-0560
Provider Business Mailing Address Fax Number:
808-531-8865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 OAHU AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96822-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-951-6424
Provider Business Practice Location Address Fax Number:
808-951-8267
Provider Enumeration Date:
05/08/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOLD
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-440-0560

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  OHCA#1253-C , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)