NPIMap

Organization Active NPI

Maui Health System a Kaiser Foundation Hospitals LLC

Doing business as Skilled Nursing and Intermediate Care Facility Kula Hospital

  • Nursing Facility/Intermediate Care Facility
  • Kula, HI
National Provider Identifier
1184079956
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
35-N Issued in HI
Legal business name
MAUI HEALTH SYSTEM A KAISER FOUNDATION HOSPITALS LLC
Doing business as
Skilled Nursing and Intermediate Care Facility Kula Hospital
Practice address
100 Keokea PL
Kula, HI 96790-7450
Phone
(808) 878-1221
NPI assigned
Apr 29, 2016
Last updated
Sep 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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

Authorized official

Name
Joyce Tamori
Title
VP, Cfo
Phone
(808) 243-3095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 35-N HI Primary

Addresses

Primary practice location

100 Keokea PL
Kula, HI 96790-7450

Mailing address

100 Keokea PL
Kula, HI 96790-7450

Other names 1

  • Skilled Nursing and Intermediate Care Facility Kula Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170602001426 HI Part A Provider - Skilled Nursing Facility 9830476159 Practice locations: Kula, HI
O20170725002612 HI Part B Supplier - Clinic/Group Practice 9830476159 Receives reassigned benefits from 139 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kula, HI; Wailuku, HI; Lanai City, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184079956. Details of each certification follow.

Skilled nursing facility certification: CCN 125003

Legal name
MAUI HEALTH SYSTEM A KAISER FOUNDATION HOSPITALS LLC
Doing business as
KULA SKILLED NURSING AND INTERMEDIATE CARE FACILITY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1967
Last certification
Jun 6, 2024
Beds
105
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Maui Health System
Most recent change of ownership
Jul 1, 2017
Organization structure
LLC
Incorporated
Dec 24, 2015 in HI
Enrollment address
100 Keokea PL
Kula, HI 96790-7450
Nursing home name
KULA HOSPITAL

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Kula HospitalCCN 125003 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jan 1, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10592.3 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Shelby D Decosta-Galdeira Individual Corporate Officer Sep 1, 2024
Richard Clay Sutherland Individual Corporate DirectorDirector, Maui Health System, a Jul 1, 2017
Anthony Paul Takitani Individual Corporate DirectorDirector, Maui Health System, a Jul 1, 2017
Barry S Shitamoto Individual Corporate Officer Jul 1, 2023
John M Yamamoto Individual Corporate DirectorDirector Jul 1, 2017
Bechara Choucair Individual Corporate Officer Jan 1, 2024
Penny Koval Individual Corporate OfficerAdministrator Nov 3, 2024
Operational/Managerial Control Nov 3, 2024
Adp of the SNF Nov 3, 2024
Kenneth L Scott Individual Operational/Managerial Control Jun 1, 2019
Adp of the SNF Jun 1, 2019
Mary M Hew Individual Corporate DirectorDirector Jul 1, 2017
Tamar Goodfellow Individual Corporate DirectorDirector, Maui Health System a Kais Mar 31, 2021
Kaiser Foundation Hospitals Organization, Oakland, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 24, 2015 100%
Operational/Managerial Control Jan 1, 2017
Lynn a Fulton Individual Corporate OfficerCeo & Hospital Adminstrator - MHS Jan 1, 2024
Operational/Managerial Control Jan 1, 2024
Adp of the SNF Jan 1, 2024
Wade Ebersole Individual Corporate OfficerVP, Coo - MHS Feb 23, 2023
Operational/Managerial ControlVP, Coo - MHS Sep 1, 2017 100%
Adp of the SNF Feb 23, 2023
Thomas S Hanenburg Individual Corporate Officer Jan 1, 2024
Debra L Cartwright Individual Corporate OfficerCfo - MHS May 1, 2023
Operational/Managerial Control May 1, 2023
Adp of the SNF May 1, 2023

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lanai Community HospitalLanai City, HI, CCN 121305 Hospital Operational/Managerial Control (100%) Jul 1, 2017
Kula HospitalKula, HI, CCN 121308 Hospital Operational/Managerial Control (100%) Jul 1, 2017
Kula HospitalKula, HI, CCN 12Z308 Hospital Operational/Managerial Control (100%) Jul 1, 2017

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 78

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

View all 78

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

Affiliated clinicians 2

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": "1461888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630627200000",
    "number": "1184079956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KEOKEA PL",
            "city": "KULA",
            "state": "HI",
            "postal_code": "967907450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 KEOKEA PL",
            "city": "KULA",
            "state": "HI",
            "postal_code": "967907450",
            "telephone_number": "808-878-1221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAUI HEALTH SYSTEM A KAISER FOUNDATION HOSPITALS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-29",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A",
        "authorized_official_last_name": "TAMORI",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_title_or_position": "VP, CFO",
        "authorized_official_telephone_number": "808-243-3095"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "HI",
            "license": "35-N",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skilled Nursing and Intermediate Care Facility Kula Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Skilled Nursing and Intermediate Care Facility Kula Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kula, HI

Sources for this page

Verify at the official NPI Registry.