Provider Demographics
NPI:1922147867
Name:PEDIAHEALTH CORP
Entity Type:Organization
Organization Name:PEDIAHEALTH CORP
Other - Org Name:KULANA MALAMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOSHIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-687-3224
Mailing Address - Street 1:91-1360 KARAYAN STREET
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:808-681-1200
Mailing Address - Fax:
Practice Address - Street 1:919 LEHUA AVE
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3328
Practice Address - Country:US
Practice Address - Phone:808-453-1919
Practice Address - Fax:808-453-1929
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ITO FAMILY HOLDINGS CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI593013-01Medicaid
HI593013-01Medicaid