Organization
HALE KUPUNA HERITAGE HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL HATA (CFO)
(808) 247-0003
Entity
Organization
Contact information
Practice address
4297C OMAO RD, KOLOA, HI 96756-9624
(808) 742-7591
(808) 742-6563
Mailing address
45-181 WAIKALUA RD, KANEOHE, HI 96744-2765
(808) 247-0003
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
61-N
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
521030-01
—
HI
Enumeration date
10/05/2005
Last updated
10/03/2022
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