Provider Demographics
NPI:1699782342
Name:KAHALA SENIOR LIVING COMMUNITY INC
Entity type:Organization
Organization Name:KAHALA SENIOR LIVING COMMUNITY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-218-7000
Mailing Address - Street 1:4389 MALIA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1106
Mailing Address - Country:US
Mailing Address - Phone:808-218-7001
Mailing Address - Fax:808-356-3610
Practice Address - Street 1:4389 MALIA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1106
Practice Address - Country:US
Practice Address - Phone:808-218-7000
Practice Address - Fax:808-218-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI71-N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI125055Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER