Provider Demographics
NPI:1124063003
Name:PC CARE CORP
Entity type:Organization
Organization Name:PC CARE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L C
Authorized Official - Last Name:YOSHIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-453-1919
Mailing Address - Street 1:919 LEHUA AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3328
Mailing Address - Country:US
Mailing Address - Phone:808-453-1919
Mailing Address - Fax:808-453-1929
Practice Address - Street 1:919 LEHUA AVE
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3328
Practice Address - Country:US
Practice Address - Phone:808-453-1919
Practice Address - Fax:808-453-1929
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ITO FAMILY HOLDINGS CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI49-N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI076801-01Medicaid
HI20453-7OtherHMSA/HMSA 65C PROVIDER #
HIB20453-3Medicare ID - Type UnspecifiedMEDICARE B PROVIDER NUMBE
HI12-5043Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER