State of Hawaii Department of Health

Office of Health Care Assurance

Medicare Section

INTERMEDIATE CARE FACILITIES FOR THE MENTALLY RETARDED

HAWAII:

NUMBER	FACILITY	LICENSED BEDS	LOCATION
1	THE ARC IN HAWAII (KAIMUKI B) 811 19^th Avenue Honolulu, Hawaii 96816 Mailing Address: 3989 Diamond Head Road Honolulu, Hawaii 96816 Phone: (808) 737-7995 Fax: (808) 732-9531 Charles Servey III, Executive Director Provider No. 12G027	5	OAHU
2	THE ARC IN HAWAII (EWA B) 91-824 B Hanakahi Street Ewa Beach, Hawaii 96706 Mailing Address: 3989 Diamond Head Road Honolulu, Hawaii 96816 Phone: (808) 737-7995 Fax: (808) 732-9531 Charles Servey III, Executive Director Provider No. 12G034	5	OAHU
3	THE ARC IN HAWAII (EWA C) 91-824 C Hanakahi Street Ewa Beach, Hawaii 96706 Mailing Address: 3989 Diamond Head Road Honolulu, Hawaii 96816 Phone: (808) 737-7995 Fax: (808) 732-9531 Charles Servey III, Executive Director Provider No. 12G035	5	OAHU
4	THE ARC IN HAWAII (WAHIAWA A) 140-A Kuahiwi Avenue Wahiawa, Hawaii 96786 Mailing Address: 3989 Diamond Head Road Honolulu, Hawaii 96816 Phone: (808) 737-7995 Fax: (808) 732-9531 Charles Servey III, Executive Director Provider No. 12G028	4	OAHU
5	THE ARC IN HAWAII (KAIMUKI A) 3705 Mahina Avenue Honolulu, Hawaii 96816 Mailing Address: 3989 Diamond Head Road Honolulu, Hawaii 96816 Phone: (808) 737-7995 Fax: (808) 732-9531 Charles Servey III, Executive Director Provider No. 12G029	5	OAHU
6	THE ARC IN HAWAII (6A) 852 Paahana Street Honolulu, Hawaii 96816 Mailing Address: 3989 Diamond Head Road Honolulu, Hawaii 96816 Phone: (808) 737-7995 Fax: (808) 732-9531 Charles Servey III Executive Director Provider No. 12G020	4	OAHU
7	THE ARC IN HAWAII (6B) 852-A Paahana Street Honolulu, Hawaii 96816 Mailing Address: 3989 Diamond Head Road Honolulu, Hawaii 96816 Phone: (808) 737-7995 Fax: (808) 732-9531 Charles Servey III, Executive Director Provider No. 12G021	4	OAHU
8	THE ARC OF MAUI (HALE KIHEI) 179 Hale Kai Street Kihei, Hawaii 96753 Mailing Address: 95 Mahalani Street, Suite 17 Cameron Center Wailuku, Hawaii 96793 Phone: (808) 242-5781 Fax: (808) 244-4061 Frank Freda, CEO Provider No. 12G036	5	MAUI
9	THE ARC OF MAUI (MANA OLA NA KEANUENUE) 450 Kanaloa Avenue Kahului, Hawaii 96732 Mailing Address: 95 Mahalani Street, Suite 17 Cameron Center Wailuku, Hawaii 96793 Phone: (808) 242-5781 Fax: (808) 244-4061 Frank Freda, CEO Provider No. 12G037	5	MAUI
10	THE ARC OF MAUI (HALE KANALOA) 450 B Kanaloa Avenue Kahului, Hawaii 96732 Mailing Address: 95 Mahalani Street, Suite 17 Cameron Center Wailuku, Hawaii 96793 Phone: (808) 242-5781 Fax: (808) 244-4061 Frank Freda, CEO Provider No. 12G038	4	MAUI
11	KULA HOSPITAL 100 Keokea Place Kula, Hawaii 96790-7450 Phone: (808) 878-1221 Fax: (808) 878-1791 Nicky Hughey, Interim Administrator Provider No. 12G001	9	MAUI
12	OPPORTUNITIES FOR THE RETARDED, INC. 64-1510 Kamehameha Highway, House 1-A Wahiawa, Hawaii 96786 Phone: (808) 622-3929 Fax: (808) 621-8227 Susanna F. Cheung, President & CEO Provider No. 12G030	5	OAHU
13	OPPORTUNITIES FOR THE RETARDED, INC. 64-1510 Kamehameha Highway, House 1-B Wahiawa, Hawaii 96786 Phone: (808) 622-3929 Fax: (808) 621-8227 Susanna F. Cheung, President & CEO Provider No. 12G031	5	OAHU
14	OPPORTUNITIES FOR THE RETARDED, INC. 64-1510 Kamehameha Highway, House 1-C Wahiawa, Hawaii 96786 Phone: (808) 622-3929 Fax: (808) 621-8227 Susanna F. Cheung, President & CEO Provider No. 12G032	5	OAHU
15	OPPORTUNITIES FOR THE RETARDED, INC. 64-1510 Kamehameha Highway, House 2-A Wahiawa, Hawaii 96786 Phone: (808) 622-3929 Fax: (808) 621-8227 Susanna F. Cheung, President & CEO Provider No. 12G039	5	OAHU
16	OPPORTUNITIES FOR THE RETARDED, INC. 64-1510 Kamehameha Highway, House 3-A Wahiawa, Hawaii 96786 Phone: (808) 622-3929 Fax: (808) 621-8227 Susanna F. Cheung, President & CEO Provider No. 12G040	5	OAHU
17	OPPORTUNITIES FOR THE RETARDED, INC. 64-1510 Kamehameha Highway, House 3-B Wahiawa, Hawaii 96786 Phone: (808) 622-3929 Fax: (808) 621-8227 Susanna F. Cheung, President & CEO Provider No. 12G041	5	OAHU
18	OPPORTUNITIES FOR THE RETARDED, INC. 64-1510 Kamehameha Highway, House 3-C Wahiawa, Hawaii 96786 Phone: (808) 622-3929 Fax: (808) 621-8227 Susanna F. Cheung, President & CEO Provider No. 12G042	5	OAHU

OHCA/MEDICARE May 27, 2009 ps