Basic Information
| Provider Information | |||||||||
| NPI: | 1437605490 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REGENCY AT PUAKEA, L.L.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | REGENCY AT PUAKEA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3326 160TH AVE SE | ||||||||
| Address2: | 120 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980086418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253924066 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2130 KANEKA ST | ||||||||
| Address2: | |||||||||
| City: | LIHUE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967668005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082464449 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2016 | ||||||||
| LastUpdateDate: | 08/30/2016 | ||||||||
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| AuthorizedOfficialLastName: | BEDDOE | ||||||||
| AuthorizedOfficialFirstName: | M. BART | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4253924066 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | OHCA#9-ALF | HI | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.