- Enrollment id
- O20200408001327
- Enrollment state
- HI
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1427619428
- Multiple npi flag
- N
- Ccn
- 125067
- Associate id
- 5991134280
- Organization name
- ISLANDS SKILLED NURSING AND REHABILITATION, LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- ISLANDS SKILLED NURSING & REHABILITATION
- Address line 1
- 1205 ALEXANDER ST
- City
- HONOLULU
- State
- HI
- Zip code
- 968261229