Provider Demographics
NPI:1043207202
Name:ANN PEARL CARE HOME, INC
Entity Type:Organization
Organization Name:ANN PEARL CARE HOME, INC
Other - Org Name:ANN PEARL NURSING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY & TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:HATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-247-0003
Mailing Address - Street 1:45-181 WAIKALUA RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2765
Mailing Address - Country:US
Mailing Address - Phone:808-247-8558
Mailing Address - Fax:808-247-4115
Practice Address - Street 1:45-181 WAIKALUA RD
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2765
Practice Address - Country:US
Practice Address - Phone:808-247-8558
Practice Address - Fax:808-247-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
HI57-N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC0000475OtherHMSA 65C
HI001594-01Medicaid
HI001594-01Medicaid