Provider Demographics
NPI:1144568452
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:CFO
Authorized Official - Prefix:MR
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:808-247-0003
Mailing Address - Fax:808-247-0018
Practice Address - Street 1:3-3367 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1034
Practice Address - Country:US
Practice Address - Phone:808-245-5121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHHA-60251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI127311Medicare PIN