Provider Demographics
NPI:1659658664
Name:CRAIGSIDE RETIREMENT RESIDENCE
Entity Type:Organization
Organization Name:CRAIGSIDE RETIREMENT RESIDENCE
Other - Org Name:15 CRAIGSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMET
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-983-1823
Mailing Address - Street 1:15 CRAIGSIDE PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1799
Mailing Address - Country:US
Mailing Address - Phone:808-523-7000
Mailing Address - Fax:808-440-0026
Practice Address - Street 1:15 CRAIGSIDE PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1799
Practice Address - Country:US
Practice Address - Phone:808-523-7000
Practice Address - Fax:808-533-5497
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARCADIA COMMUNITY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-04
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI79-N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI125063Medicare Oscar/Certification