Provider Demographics
NPI:1194156604
Name:LIFE CARE CENTER OF KONA
Entity type:Organization
Organization Name:LIFE CARE CENTER OF KONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:POMAIKAI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDUHA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:808-322-2790
Mailing Address - Street 1:78-6957 KAMEHAMEHA III RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:78-6957 KAMEHAMEHA III RD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2528
Practice Address - Country:US
Practice Address - Phone:808-322-2790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy