Provider Demographics
NPI:1477875318
Name:MALAMA OHANA NURSING AND REHAB CENTER
Entity Type:Organization
Organization Name:MALAMA OHANA NURSING AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP-CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:RISSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-432-5275
Mailing Address - Street 1:3288 MOANALUA RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1469
Mailing Address - Country:US
Mailing Address - Phone:808-432-0000
Mailing Address - Fax:
Practice Address - Street 1:3288 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1469
Practice Address - Country:US
Practice Address - Phone:808-432-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAISER FOUNDATION HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-19
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI78-N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI125060Medicare PIN