Provider Demographics
NPI:1356494157
Name:TAK PROPERTIES, LLC.
Entity type:Organization
Organization Name:TAK PROPERTIES, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:G
Authorized Official - Last Name:TOLENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-671-2528
Mailing Address - Street 1:94-141 PUPUPUHI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2510
Mailing Address - Country:US
Mailing Address - Phone:808-671-2528
Mailing Address - Fax:808-678-1894
Practice Address - Street 1:91-2139 FORT WEAVER RD
Practice Address - Street 2:ST. FRANCIS MEDICAL PLAZA-WEST #101A
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3607
Practice Address - Country:US
Practice Address - Phone:808-676-2688
Practice Address - Fax:808-676-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-1339261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI501032-04Medicaid
HI100384Medicare ID - Type Unspecified