Provider Demographics
NPI:1851051106
Name:GAMMIE HOMECARE, INC.
Entity type:Organization
Organization Name:GAMMIE HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMABUKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-877-4063
Mailing Address - Street 1:292 ALAMAHA ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2418
Mailing Address - Country:US
Mailing Address - Phone:808-877-4032
Mailing Address - Fax:808-442-0409
Practice Address - Street 1:98-199 KAMEHAMEHA HWY STE E4
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4820
Practice Address - Country:US
Practice Address - Phone:808-597-8087
Practice Address - Fax:808-442-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI023110Medicaid