Provider Demographics
NPI:1013416270
Name:HUAPALA SENIOR CARE C, LLC
Entity Type:Organization
Organization Name:HUAPALA SENIOR CARE C, LLC
Other - Org Name:MANOA SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-440-0560
Mailing Address - Street 1:918 12TH AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2251
Mailing Address - Country:US
Mailing Address - Phone:808-440-0560
Mailing Address - Fax:
Practice Address - Street 1:2649C HUAPALA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1653
Practice Address - Country:US
Practice Address - Phone:808-440-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home