Provider Demographics
NPI:1619157922
Name:PALOLO CHINESE HOME
Entity Type:Organization
Organization Name:PALOLO CHINESE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKAYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-748-4901
Mailing Address - Street 1:2459 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3051
Mailing Address - Country:US
Mailing Address - Phone:808-737-2555
Mailing Address - Fax:808-735-1754
Practice Address - Street 1:2459 10TH AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3051
Practice Address - Country:US
Practice Address - Phone:808-737-2555
Practice Address - Fax:808-735-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI70-N313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI624503Medicaid
HI125059Medicare Oscar/Certification