Provider Demographics
NPI:1376525584
Name:DIVERSIFIED MEDICAL ENTERPRISES INC
Entity Type:Organization
Organization Name:DIVERSIFIED MEDICAL ENTERPRISES INC
Other - Org Name:THE CARE CENTER OF HONOLULU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-919-0618
Mailing Address - Street 1:1900 BACHELOT STREET
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2431
Mailing Address - Country:US
Mailing Address - Phone:808-531-5302
Mailing Address - Fax:808-538-3219
Practice Address - Street 1:1900 BACHELOT ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2431
Practice Address - Country:US
Practice Address - Phone:808-531-5302
Practice Address - Fax:808-538-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI16N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00186901Medicaid
HI125019Medicare Oscar/Certification
HI125019Medicare PIN