Provider Demographics
NPI:1083605836
Name:LIFE CARE SERVICES OF HAWAII LLC
Entity Type:Organization
Organization Name:LIFE CARE SERVICES OF HAWAII LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:I
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-875-4500
Mailing Address - Street 1:1314 KALAKAUA AVE, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1908
Mailing Address - Country:US
Mailing Address - Phone:808-893-4444
Mailing Address - Fax:808-983-4499
Practice Address - Street 1:1314 KALAKAUA AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1908
Practice Address - Country:US
Practice Address - Phone:808-983-4444
Practice Address - Fax:808-983-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOHCA-55-N310400000X
HIOHCA#55-N314000000X
HI55-N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA214328Medicaid
125047Medicare Oscar/Certification