NPIMap

Organization Active NPI

Ann Pearl Care Home, Inc

  • Skilled Nursing Facility
  • Kaneohe, HI
National Provider Identifier
1043207202
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
57-N Issued in HI
Legal business name
ANN PEARL CARE HOME, INC
Practice address
45-181 Waikalua Rd
Kaneohe, HI 96744-2765
Phone
(808) 247-8558
Fax
(808) 247-4115
NPI assigned
Oct 3, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Randall Hata
Title
Secretary & Treasurer
Phone
(808) 247-0003

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X
Skilled Nursing Facility 314000000X 57-N HI Primary

Addresses

Primary practice location

45-181 Waikalua Rd
Kaneohe, HI 96744-2765

Mailing address

45-181 Waikalua Rd
Kaneohe, HI 96744-2765
Phone (808) 247-8558

Other identifiers 2

IdentifierTypeStateIssuer
C0000475OtherHIHMSA 65C
001594-01MedicaidHI

Other names 1

  • Ann Pearl Nursing Facility Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170207002282 HI Part A Provider - Skilled Nursing Facility 8224311717 Practice locations: Kaneohe, HI

Skilled nursing facility certification: CCN 125048

Legal name
ANN PEARL CARE HOME INC
Doing business as
OHANA PACIFIC HEALTH
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 28, 1998
Last certification
Feb 28, 2025
Beds
104
Ownership / control type
Corporation
Multi-facility organization
Ohana Pacific Management Company
Organization structure
CorporationProprietary
Enrollment address
45-181 Waikalua Rd
Kaneohe, HI 96744-2765
Nursing home name
ANN PEARL NURSING FACILITY
Affiliated entity
OHANA PACIFIC MANAGEMENT CO.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Ann Pearl Nursing FacilityCCN 125048
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Dec 28, 1998
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10457.6 residents per day on average
Chain
Ohana Pacific Management Co.6 facilities in the chain
Special focus status
SFF Candidate
Penalties (3 years)
1Fines totaling $15,288

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
12D0943787Ann Pearl Nursing Facility45-181 Waikalua Rd, Kaneohe, HI 96744Certificate of waiverApr 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
Ann Pearl Care Home Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • Direct secure messaging: kaneohe.ann.pearl.rehabilitation.and.healthcare@hawaiihie.medicity.net

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rebecca Canon-Fratis Individual Operational/Managerial Control Mar 1, 2022
Adp of the SNF Mar 1, 2022
Clifford Miller Individual Adp of the SNF Jul 1, 1998
Richard S. Kishaba 2010 Dynasty Trust Organization, Kaneohe, HI 5% Or Greater Indirect Ownership Interest Jul 30, 2010 90%
Ohana Pacific Management Company Inc Organization, Kaneohe, HI Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 1, 1999 100%
Operational/Managerial Control Oct 1, 1999
Adp of the SNF Dec 11, 2025
Randall I Hata Individual Corporate OfficerVP/Treasurer/Secretary Oct 1, 2001
Corporate DirectorDirector Oct 1, 2001
Operational/Managerial Control Oct 1, 2001
Adp of the SNF Oct 1, 2001
Gordon Beh Individual Operational/Managerial Control Feb 24, 2025
Adp of the SNF Feb 24, 2025
Richard S Kishaba Individual 5% Or Greater Indirect Ownership Interest Jan 1, 1999 10%
Corporate OfficerPresident Jan 1, 1999
Corporate DirectorChairman of the Board Jan 1, 1999
Operational/Managerial Control Jan 1, 1999
Adp of the SNF Jan 1, 1999
Wesley Lo Individual Operational/Managerial Control Jan 1, 2020
Adp of the SNF Jan 1, 2020
Andrew Lore Individual Operational/Managerial Control Feb 1, 2022
Adp of the SNF Feb 1, 2022
Pamela McClennon Individual Operational/Managerial Control Apr 1, 2025
Adp of the SNF Apr 1, 2025
Suanne Morikuni Individual Operational/Managerial Control Jan 1, 2019
Adp of the SNF Jan 1, 2019
First Hawaiian Bank Organization, Honolulu, HI Corporation, Financial institution, For-profit, Owned by another organization or individual 5% Or Greater Mortgage Interest Nov 6, 2013 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1043207202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45-181 WAIKALUA RD",
            "city": "KANEOHE",
            "state": "HI",
            "postal_code": "967442765",
            "telephone_number": "808-247-8558",
            "fax_number": "808-247-4115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45-181 WAIKALUA RD",
            "city": "KANEOHE",
            "state": "HI",
            "postal_code": "967442765",
            "telephone_number": "808-247-8558",
            "fax_number": "808-247-4115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANN PEARL CARE HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "HATA",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "SECRETARY & TREASURER",
        "authorized_official_telephone_number": "808-247-0003"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "HI",
            "license": "57-N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA 65C",
            "identifier": "C0000475",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001594-01",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ann Pearl Nursing Facility",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ann Pearl Nursing Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kaneohe, HI

Sources for this page

Verify at the official NPI Registry.