Provider Demographics
NPI:1427619428
Name:ISLANDS SKILLED NURSING AND REHABILITATION LLC
Entity type:Organization
Organization Name:ISLANDS SKILLED NURSING AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-576-3070
Mailing Address - Street 1:12680 HIGH BLUFF DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2232
Mailing Address - Country:US
Mailing Address - Phone:918-576-3070
Mailing Address - Fax:918-516-0609
Practice Address - Street 1:1205 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1229
Practice Address - Country:US
Practice Address - Phone:808-773-8700
Practice Address - Fax:808-773-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility