Provider Demographics
NPI:1285342378
Name:PSH KM LLC
Entity type:Organization
Organization Name:PSH KM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-521-0707
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:808-687-3224
Mailing Address - Fax:808-687-3209
Practice Address - Street 1:91-1360 KARAYAN ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-1985
Practice Address - Country:US
Practice Address - Phone:808-681-1200
Practice Address - Fax:808-681-1238
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC SKILLED HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric