Provider Demographics
NPI:1558346528
Name:MAUNALANI NURSING AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:MAUNALANI NURSING AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAICHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANTAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-732-0771
Mailing Address - Street 1:5113 MAUNALANI CIR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-4019
Mailing Address - Country:US
Mailing Address - Phone:808-732-0771
Mailing Address - Fax:808-735-5980
Practice Address - Street 1:5113 MAUNALANI CIR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-4019
Practice Address - Country:US
Practice Address - Phone:808-732-0771
Practice Address - Fax:808-735-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5N313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00134101Medicaid
HIA00156OtherHMSA
HIA00156OtherBLUE CROSS BLUE SHIELD
HMSA65C+OtherENTERAL DMERC
HI0604220001OtherCIGNA
HI0604220001Medicare NSC
HI125013Medicare Oscar/Certification