Provider Demographics
NPI:1912907759
Name:HALE MAKUA HEALTH SERVICES
Entity Type:Organization
Organization Name:HALE MAKUA HEALTH SERVICES
Other - Org Name:HALE MAKUA - WAILUKU
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-877-2761
Mailing Address - Street 1:472 KAULANA ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2050
Mailing Address - Country:US
Mailing Address - Phone:808-877-2761
Mailing Address - Fax:808-871-9262
Practice Address - Street 1:1540 LOWER MAIN ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1958
Practice Address - Country:US
Practice Address - Phone:808-243-1722
Practice Address - Fax:808-243-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI73-N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI081553-01Medicaid
HI125056Medicare ID - Type Unspecified
HI081553-01Medicaid