Provider Demographics
NPI:1093315251
Name:STAY AT HOME HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:STAY AT HOME HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:I
Authorized Official - Last Name:HATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-791-4496
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:808-247-0003
Mailing Address - Fax:808-247-0018
Practice Address - Street 1:2943 KRESS ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1815
Practice Address - Country:US
Practice Address - Phone:808-246-6919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAY AT HOME HEALTHCARE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-27
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI804171Medicaid