Provider Demographics
NPI:1578560025
Name:OAHU HEALTHCARE, LLC
Entity Type:Organization
Organization Name:OAHU HEALTHCARE, LLC
Other - Org Name:KA PUNAWAI OLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY TO LCCA, MGR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-473-5867
Mailing Address - Street 1:3001 KEITH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3713
Mailing Address - Country:US
Mailing Address - Phone:423-473-5751
Mailing Address - Fax:423-339-8342
Practice Address - Street 1:91-575 FARRINGTON HIGHWAY
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707
Practice Address - Country:US
Practice Address - Phone:808-674-9262
Practice Address - Fax:808-674-9623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI59-N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000225359OtherHMSA PPO
HI518524Medicaid
HI74584OtherKAISER
HIA225357OtherHMSA PPO
HIA225357OtherHMSA PPO
HI518524Medicaid