Provider Demographics
NPI:1033585732
Name:KAUMANA DRIVE PARTNERS LLC
Entity Type:Organization
Organization Name:KAUMANA DRIVE PARTNERS LLC
Other - Org Name:LEGACY HILO REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-940-6929
Mailing Address - Street 1:2131 PALOMAR AIRPORT RD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1433
Mailing Address - Country:US
Mailing Address - Phone:949-940-6929
Mailing Address - Fax:760-820-9040
Practice Address - Street 1:563 KAUMANA DR
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1812
Practice Address - Country:US
Practice Address - Phone:808-498-0100
Practice Address - Fax:808-935-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
HI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI125065Medicare Oscar/Certification