Provider Demographics
NPI:1306046602
Name:CARERESOURCE HAWAII
Entity type:Organization
Organization Name:CARERESOURCE HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:THAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKASUGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-599-9999
Mailing Address - Street 1:680 IWILEI RD
Mailing Address - Street 2:SUITE 660
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5388
Mailing Address - Country:US
Mailing Address - Phone:808-599-4999
Mailing Address - Fax:808-531-2832
Practice Address - Street 1:680 IWILEI RD
Practice Address - Street 2:SUITE 660
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5388
Practice Address - Country:US
Practice Address - Phone:808-534-4224
Practice Address - Fax:808-531-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHHA-16251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI533390-01Medicaid
HI533390-05Medicaid
HI533390-03Medicaid
HI533390-04Medicaid
HI533390-02Medicaid