Provider Demographics
NPI:1528791068
Name:MANOA SENIOR LIVING LLC
Entity type:Organization
Organization Name:MANOA SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD, CNA
Authorized Official - Phone:808-753-0145
Mailing Address - Street 1:3147 KAHIWA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1544
Mailing Address - Country:US
Mailing Address - Phone:808-753-0145
Mailing Address - Fax:855-509-0220
Practice Address - Street 1:3147 KAHIWA PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1544
Practice Address - Country:US
Practice Address - Phone:808-753-0145
Practice Address - Fax:855-509-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home