Organization
PANCHO AND JAYVIE'S ADULT FOSTER CARE HOME
Active
Other names
none
Organization subpart
No
Provider details
NPI number
Authorized official
JAYVIE AGCAOILI SUMOBA CNA (OWNER)
(808) 982-5004
Entity
Organization
Contact information
Practice address
16-123 AINALOA BOULEVARD, KEAAU, HI 96749
(808) 982-5004
(808) 982-5004
Mailing address
RR 3 BOX 1009, PAHOA, HI 96778-7500
(808) 982-5004
(808) 982-5004
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
W02297664-01
HI
Other
Enumeration date
12/14/2006
Last updated
06/23/2008
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