Provider Demographics
NPI:1730176488
Name:PRIME CARE SERVICES HAWAII INC
Entity type:Organization
Organization Name:PRIME CARE SERVICES HAWAII INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:I
Authorized Official - Last Name:HATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-791-4496
Mailing Address - Street 1:3375 KOAPAKA ST
Mailing Address - Street 2:SUITE I-570
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1800
Mailing Address - Country:US
Mailing Address - Phone:808-531-0050
Mailing Address - Fax:808-531-1158
Practice Address - Street 1:3375 KOAPAKA ST
Practice Address - Street 2:SUITE I-570
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1800
Practice Address - Country:US
Practice Address - Phone:808-531-0050
Practice Address - Fax:808-531-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHHA-31251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI086481Medicaid
HI086481Medicaid