Provider Demographics
NPI:1417022435
Name:CAREMAX HAWAII, INC.
Entity Type:Organization
Organization Name:CAREMAX HAWAII, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DYRON
Authorized Official - Middle Name:B
Authorized Official - Last Name:CASTULO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-479-8052
Mailing Address - Street 1:91-1123 HOOMAHANA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4630
Mailing Address - Country:US
Mailing Address - Phone:808-356-8468
Mailing Address - Fax:808-685-6591
Practice Address - Street 1:94-615 KUPUOHI ST STE 201
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5329
Practice Address - Country:US
Practice Address - Phone:808-479-8052
Practice Address - Fax:808-685-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI578578-01Medicaid
HI578578-01Medicaid