Provider Demographics
NPI:1992228431
Name:MALOHA GROUP, CORP. DBA ISLAND PACIFIC CARE
Entity type:Organization
Organization Name:MALOHA GROUP, CORP. DBA ISLAND PACIFIC CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSULTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-762-7507
Mailing Address - Street 1:PO BOX 894824
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-8331
Mailing Address - Country:US
Mailing Address - Phone:808-762-7507
Mailing Address - Fax:808-762-7508
Practice Address - Street 1:94-210 PUPUKAHI ST STE 204
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2649
Practice Address - Country:US
Practice Address - Phone:808-762-7507
Practice Address - Fax:808-762-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 372500000X, 376J00000X, 376K00000X
HIGE-072-517-0176-01253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1992228431Medicaid