Provider Demographics
NPI:1154325405
Name:KUAKINI GERIATRIC CARE, INC.
Entity Type:Organization
Organization Name:KUAKINI GERIATRIC CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAJIWARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-547-9231
Mailing Address - Street 1:347 N KUAKINI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2306
Mailing Address - Country:US
Mailing Address - Phone:808-547-9231
Mailing Address - Fax:808-547-9547
Practice Address - Street 1:347 N KUAKINI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2306
Practice Address - Country:US
Practice Address - Phone:808-536-2236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI25-N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI006236Medicaid
HI006236Medicaid