Provider Demographics
NPI:1992085633
Name:ICARE OF THE PACIFIC LLC
Entity type:Organization
Organization Name:ICARE OF THE PACIFIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTULO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-685-5300
Mailing Address - Street 1:91-1123 HOOMAHANA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4630
Mailing Address - Country:US
Mailing Address - Phone:808-685-5300
Mailing Address - Fax:808-685-6591
Practice Address - Street 1:98-027 HEKAHA ST STE 3
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4919
Practice Address - Country:US
Practice Address - Phone:808-685-5300
Practice Address - Fax:808-685-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies