State of Hawaii Department of Health

Office of Health Care Assurance

Medicare Section

SKILLED NURSING/INTERMEDIATE CARE FACILITIES

HAWAII:

NUMBER	FACILITY	ADULT DAY HEALTH CENTER	**TYPE/NUMBER OF CERTIFIED BEDS	*TYPE/NUMBER OF LICENSED BEDS	LOCATION
1	ALOHA NURSING & REHAB CENTRE 45-545 Kamehameha Highway Kaneohe, Hawaii 96744 Ph: (808) 247-2220 Fax: (808) 235-3676 Amy Yamashiro Lee Administrator Provider No. 125038		141 SNF/NF	141 SNF/ICF	OAHU
2	ANN PEARL NURSING FACILITY 45-181 Waikalua Road Kaneohe, Hawaii 96744 Ph: (808) 247-8558 Fax: (808) 247-4115 Johhna Johnson Administrator Provider No. 125048	X	104 SNF/NF	104 SNF/ICF	OAHU
3	ARCADIA RETIREMENT RESIDENCE 1434 Punahou Street Honolulu, Hawaii 96822 Ph: (808) 941-0941 Fax: (808) 949-4965 Karen Thorp Administrator Provider No. 125014		11 SNF	81 SNF/ICF	OAHU
4	AVALON CARE CENTER - HONOLULU, LLC 1930 Kamehameha IV Road Honolulu, Hawaii 96819 Ph: (808) 847-4834 Fax: (808) 848-8020 Walter H. Long Administrator Provider No. 125020		108 SNF/NF	108 SNF/ICF	OAHU
5	CONVALESCENT CENTER OF HONOLULU 1900 Bachelot Street Honolulu, Hawaii 96817 Ph: (808) 531-5302 Fax: (808) 538-3219 C. Gerald Powers, Ph.D Administrator Provider No. 125019		182 SNF/NF	182 SNF/ICF	OAHU
6	CRAWFORD’S CONVALESCENT HOME 58-130 Kamehameha Highway Haleiwa, Hawaii 96712 Ph: (808) 638-8514 Fax: (808) 638-8516 Alice Kim Lew Administrator Provider No. 12E007		55 NF	55 ICF	OAHU
7	GARDEN ISLE HEALTHCARE 3-3420 Kuhio Highway #300 Lihue, Hawaii 96766 Ph: (808) 245-1802 Fax: (808) 245-6515 Kurt Akamine Administrator Provider No. 125004		110 SNF/NF	110 SNF/ICF	KAUAI
8	HALE ANUENUE RESTORATIVE CARE CENTER 1333 Waianuenue Avenue Hilo, Hawaii 96720 Ph: (808) 961-6644 Fax: (808) 961-6630 Ivan S. Yamamoto Executive Director Provider No. 125045		120 SNF/NF	120 SNF/ICF	HAWAII
9	HALE HO ALOHA 2670 Pacific Heights Road Honolulu, Hawaii 96813 Ph: (808) 524-1955 Fax:(808) 537-5418 Dennis Okimoto Administrator			59 SNF/ICF	OAHU
10	HALE HO’OLA HAMAKUA 45-547 Plumeria Street Honokaa, Hawaii 96727 Ph: (808) 775-7211 Fax: (808) 775-9977 Jeanne Abe Interim Administrator Provider No. 125032		46 SNF/NF	46 SNF/ICF	HAWAII
11	HALE KUPUNA HERITAGE HOME, LLC 4297 A Omao Road Koloa, Hawaii 96756 Mailing Address: P.O. Box 1287 Koloa, Hawaii 96756-1287 Ph: (808) 742-7591 Fax: (808) 742-6563 Alisa Racelo Acting Administrator Provider No. 12E030		84 NF	84 SNF/ICF	KAUAI
12	HALE MAKUA (Kahului) 472 Kaulana Street Kahului, Hawaii 96732 Ph: (808) 877-2761 Fax: (808) 871-9262 Ted Tucker Administrator in Training Provider No. 125007	X	254 SNF/NF	254 SNF/ICF	MAUI
13	HALE MAKUA (Wailuku) 1540 Lower Main Street Wailuku, Hawaii 96793 Ph: (808) 243-1722 Fax: (808) 243-1744 Tony Krieg Administrator Provider No. 125056		124 SNF/NF	124 SNF/ICF	MAUI
14	HALE MALAMALAMA 6163 Summer Street Honolulu, Hawaii 96821 Ph: (808) 396-0537 Fax: (808) 396-5128 Pauline Y.O. Fukumura Administrator Provider No. 125050		40 SNF/NF	40 SNF/ICF	OAHU
15	HALE NANI REHABILITATION AND NURSING CENTER 1677 Pensacola Street Honolulu, Hawaii 96822 Ph: (808) 537-3371 Fax: (808) 528-1613 John Megara Administrator Provider No. 125011		288 SNF/NF	288 SNF/ICF	OAHU
16	HALE OLA KINO 1314 Kalakaua Avenue Honolulu, Hawaii 96826 Ph: (808) 983-4400 Fax: (808) 983-4490 Jolene Kageyama Acting Administrator Provider No. 125047		26 SNF 6 SNF/NF	32 SNF/ICF	OAHU
17	HARRY AND JEANETTE WEINBERG CARE CENTER 45-090 Namoku Street Kaneohe, Hawaii 96744 Ph: (808) 247-1670 Fax: (808) 235-9661 Katheryn Pipho Interim Administrator Provider No. 125033		44 SNF/NF	44 SNF/ICF	KAUAI
18	HAWAII MEDICAL CENTER EAST 2230 Liliha Street Honolulu, Hawaii 96817 Ph: (808) 547-6011 Fax: (808) 547-6616 Salim Hasham Administrator Provider No. 125025		52 SNF/NF	52 SNF	OAHU
19	HILO MEDICAL CENTER 1190 Waianuenue Avenue Hilo, Hawaii 96720 Ph: (808) 974-4700 Fax: (808) 974-4746 Howard N. Ainsley Chief Executive Officer Provider No. 125002		112 SNF/NF 22 SNF/DP	112 SNF/ICF 22 SNF	HAWAII
20	HI’OLANI CARE CENTER AT KAHALA NUI 4398 Malia Street Honolulu, Hawaii 96821 Ph: (808) 218-7000 Fax: (808) 218-7014 Wendy Wong Acting Administrator Provider No. 125055		16 SNF 4 SNF/NF	60 SNF/ICF	OAHU
21	HOSPICE HAWAII, INC. 566 Papalani Street Kailua, Hawaii 96734 Mailing Address: 860 Iwilei Road Honolulu, Hawaii 96817-5018 Ph: (808) 924-9255 Fax: (808) 922-9161 Kenneth Zeri, RN, MS President & CPO			5 SNF	OAHU
22	ISLAND NURSING HOME 1205 Alexander Street Honolulu, Hawaii 96826 Ph: (808) 946-5027 Fax: (808) 941-5202 Leland Yagi Administrator Provider No. 125005		42 SNF/NF	42 SNF/ICF	OAHU
23	KA PUNAWAI OLA 91-575 Farrington Highway Kapolei, Hawaii 96707 Ph: (808) 674-9262 Fax: (808) 674-9623 Fred Horwitz Administrator Provider No. 125051		26 SNF 94 SNF/NF	120 SNF/ICF	OAHU
24	KAHUKU MEDICAL CENTER 56-117 Pualalea Street Kahuku, Hawaii 96731 Ph: (808) 293-9221 Fax: (808) 293-2262 Lance Segawa Administrator Provider No. 125030		10 SNF/NF	10 SNF/ICF	OAHU
25	KFH – MALAMA OHANA NURSING & REHAB CENTER 3288 Moanalua Road Honolulu, Hawaii 96819 Ph: (808) 432-7737 Fax: (808) 432-7775 Susan R. Murray Vice President, Quality & Services and Hospital Administrator Provider No. 125060			28 SNF/ICF	OAHU
26	KAU HOSPITAL 1 Kamani Street Pahala, Hawaii 96777 Mailing Address: P.O. Box 40 Pahala, Hawaii 96777 Ph: (808) 928-2050 Fax: (808) 928-8980 Merilyn Harris Administrator Provider No. 125028	X	16 SNF/NF	16 SNF/ICF	HAWAII
27	KAUAI CARE CENTER 9611 Waena Road Waimea, Hawaii 96796 Mailing Address: P.O. Box 507 Waimea, Hawaii 96796 Ph: (808) 338-1681 Fax: (808) 338-1297 Liza Trinidad Administrator Provider No. 12E034		38 NF	38 SNF/ICF	KAUAI
28	KAUAI VETERANS MEMORIAL HOSPITAL 4643 Waimea Canyon Road Waimea, Hawaii 96796 Mailing Address: P.O. Box 337 Waimea, Hawaii 96796 Ph: (808) 338-9431 Fax: (808) 338-9420 Orianna Skomoroch, M.A., C.R.A. Chief Executive Officer Provider No. 125021		20 SNF/NF	20 SNF/ICF	KAUAI
29	KOHALA HOSPITAL 54-383 Hospital Road Kapaau, Hawaii 96755 Mailing Address: P.O. Box 10 Kapaau, Hawaii 96755 Ph: (808) 889-6211 Fax: (808) 889-6978 Patricia Kalua, RN,MSN, MAOM Hospital Administrator Provider No. 125031		24 SNF/NF	24 SNF/ICF	HAWAII
30	KONA COMMUNITY HOSPITAL 79-1019 Haukapila Street Kealakekua, Hawaii 96750 Ph: (808) 322-9311 Fax: (808) 322-4479 Donald Lewis Regional Chief Executive Officer Provider No. 125027		34 SNF/NF	34 SNF/ICF	HAWAII
31	KUAKINI GERIATRIC CARE 347 North Kuakini Street Honolulu, Hawaii 96817 Ph: (808) 547-9357 Fax: (808) 547-9547 Gary K. Kajiwara President & Chief Executive Officer Provider No. 125026		40 SNF/NF 147 NF	187 SNF/ICF	OAHU
32	KULA HOSPITAL 100 Keokea Place Kula, Hawaii 96790-7450 Ph: (808) 878-1221 Fax: (808) 878-1791 Nick Hughey Interim Administrator Provider No. 125003		99 SNF/NF	99 SNF/ICF	MAUI
33	KULANA MALAMA 91-1360 Karayan Street Ewa Beach, Hawaii 96706 Ph: (808) 681-1203 Fax: (808) 453-1929 Sister Alicia Damien Lau Administrator Provider No. 125057		30 SNF/NF	30 SNF	OAHU
34	LANAI COMMUNITY HOSPITAL 158 7^th Street Lanai City, Hawaii 96763 Mailing Address: P.O. Box 630650 Lanai City, Hawaii 96763 Ph: (808) 565-6411 Fax: (808) 565-6887 Paul Harper, RN Interim Administrator Provider No. 125023		10 SNF/NF	10 SNF/ICF	LANAI
35	LEAHI HOSPITAL 3675 Kilauea Avenue Honolulu, Hawaii 96816 Ph: (808) 733-8000 Fax: (808) 733-7914 Vincent H. S. Lee, FACHE Oahu Region CEO Provider No. 125010	X	179 SNF/NF	98 SNF 81 ICF	OAHU
36	LEEWARD INTEGRATED HEALTH SERVICES 84-390 Jade Street Waianae, Hawaii 96792 Ph: (808) 695-9508 Fax: (808) 695-0225 Douglas A. Borton Administrator Provider No. 125046		93 SNF/NF	93 SNF/ICF	OAHU
37	LIFE CARE CENTER OF HILO 944 West Kawailani Street Hilo, Hawaii 96720 Ph: (808) 959-9151 Fax: (808) 959-6202 Fred Horwitz Executive Director Provider No. 125040		252 SNF/NF	252 SNF/ICF	HAWAII
38	LIFE CARE CENTER OF KONA 78-6957 Kamehameha III Road Kona, Hawaii 96740 Ph: (808) 322-2790 Fax: (808) 324-1750 Fred Horwitz Executive Director Provider No. 125052		94 SNF/NF	94 SNF/ICF	HAWAII
39	LILIHA HEALTHCARE CENTER 1814 Liliha Street Honolulu, Hawaii 96817 Ph: (808) 537-9557 Fax: (808) 599-4722 Nicomedes G. Santos, NHA Administrator Provider No. 125041		92 SNF/NF	92 SNF/ICF	OAHU
40	MALUHIA 1027 Hala Drive Honolulu, Hawaii 96817 Ph: (808) 832-3000 Fax: (808) 832-3039 Ken Takeuchi Interim Administrator Provider No. 125009	X	158 SNF/NF	158 SNF/ICF	OAHU
41	MAUNALANI NURSING AND REHABILITATION CENTER 5113 Maunalani Circle Honolulu, Hawaii 96816 Ph: (808) 732-0771 Fax: (808) 735-5980 Sai Chantavy Executive Director Provider No. 125013		41 SNF/DP 59 SNF/NF	100 SNF/ICF	OAHU
42	MOLOKAI GENERAL HOSPITAL 280 Home Olu Place Kaunakakai, Hawaii 96748 Mailing Address: P.O. Box 408 Kaunakakai, Hawaii 96748 Ph: (808) 553-5331 Fax: (808) 553-3133 Janice Kalanihuia President Provider No. 125034		2 SNF/NF	2 SNF/ICF	MOLOKAI
43	NUUANU HALE 2900 Pali Highway Honolulu, Hawaii 96817 Ph: (808) 595-6311 Fax: (808) 595-6188 Gayle Lau, NHA Administrator Provider No. 125024		75 SNF/NF	75 SNF/ICF	OAHU
44	OAHU CARE FACILITY 1808 South Beretania Street Honolulu, Hawaii 96826 Ph: (808) 973-1900 Fax: (808) 973-1910 Randall Ito Administrator Provider No. 125042		82 SNF/NF	82 SNF/ICF	OAHU
45	PALOLO CHINESE HOME 2459 10^TH Avenue Honolulu, Hawaii 96816-3098 Ph: (808) 737-2555 Fax: (808) 735-1754 Darlene H. Nakayama, RN Administrator Provider No. 125059		43 SNF/NF	61 SNF/ ICF	OAHU
46	PEARL CITY NURSING HOME 919 Lehua Avenue Pearl City, Hawaii 96782 Ph: (808) 453-1919 Fax: (808) 453-1929 Bernadette Ledesma Administrator Provider No. 125043		122 SNF/NF	122 SNF/ICF	OAHU
47	THE QUEEN’S MEDICAL CENTER – PCU 1301 Punchbowl Street Honolulu, Hawaii 96813 Ph: (808) 538-9011 Fax: (808) 547-4646 Catherine Young Administrator Provider No. 125037		28 SNF/NF	28 SNF	OAHU
48	SAMUEL MAHELONA MEMORIAL HOSPITAL 4800 Kawaihau Road Kapaa, Hawaii 96746 Ph: (808) 822-4961 Fax: (808) 823-4100 Myra B.W. Ornellas, RN Interim Hospital Administrator Provider No. 125029		66 SNF/NF	66 SNF/ICF	KAUAI
49	WAHIAWA GENERAL HOSPITAL 128 Lehua Street Wahiawa, Hawaii 96786 Ph: (808) 621-4211 Fax: (808) 621-4490 R. Don Olden Chief Executive Officer Provider No. 125015		103 SNF/NF	103 SNF/ICF	OAHU
50	YUKIO OKUTSU STATE VETERANS HOME 1180 Waianuenue Avenue Hilo, Hawaii 96720 Ph: (808) 961-1500 John Johnson Administrator Provider No. 125058	X		95 SNF/ICF	HAWAII

SKILLED NURSING/INTERMEDIATE CARE FACILITIES

PACIFIC AREA (AMERICAN SAMOA, GUAM, AND SAIPAN):

NUMBER	FACILITY	ADULT DAY HEALTH CENTER	**TYPE/NUMBER OF CERTIFIED BEDS	*TYPE/NUMBER OF LICENSED BEDS	LOCATION
1	GUAM MEMORIAL HOSPITAL AUTHORITY 499 North Sabana Drive Barrigada, Guam 96913 Mailing Address: 850 Governor Carlos Camacho Road Tamuning, Guam 96911 Ph: (671) 633-1800 Fax: (671) 633-1802 Peter John Camacho Hospital Administrator/CEO Provider No. 65-5000		40 SNF/NF		GUAM

OHCA/Medicare February 3, 2010 kh

LEGEND:

* ICF - Intermediate Care Facility (Level of Care)2.

* SNF - Skilled Nursing Facility (Level of Care)

** DP - Distinct Part

** NF - Nursing Facility (Title XIX Medicaid Reimbursement)

** SNF - Skilled Nursing Facility (Title XVIII Medicare Reimbursement)

** SNF/NF - Skilled Nursing/Nursing Facility (Title XVIII/XIX Medicaid/Medicare Reimbursement)