NPIMap

Organization Active NPI

Kauai Care Center, LLC

  • Skilled Nursing Facility
  • Kauai, HI
National Provider Identifier
1689618308
Registry record updated Mar 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
KAUAI CARE CENTER, LLC
Practice address
9611 Waena Road
Kauai, HI 96796
Phone
(808) 338-1681
Fax
(808) 338-1297
NPI assigned
Jun 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2023

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

Authorized official

Name
Marvin Beddoe
Title
Ceo
Phone
(425) 392-4066

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

9611 Waena Road
Kauai, HI 96796

Mailing address

3326 160TH Ave SE
Bellevue, WA 98008-6418
Phone (425) 392-4066

Other identifiers 1

IdentifierTypeStateIssuer
0-03831-1MedicaidHI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120907000090 CA Part A Provider - Skilled Nursing Facility 3779775259 Practice locations: Waimea, HI

Skilled nursing facility certification: CCN 125061

Legal name
KAUAI CARE CENTER, LLC
Doing business as
KAUAI CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 8, 2011
Last certification
Apr 5, 2024
Beds
53
Ownership / control type
Individual
Organization structure
LLCProprietary
Incorporated
Apr 25, 2002 in HI
Enrollment address
9611 Waena Rd
Waimea, HI 96796
Nursing home name
KAUAI CARE CENTER
Affiliated entity
REGENCY PACIFIC MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Kauai Care CenterCCN 125061
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Aug 8, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5346.8 residents per day on average
Chain
Regency Pacific Management27 facilities in the chain

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
12D0684203Kauai Care Center9611 Waena Rd, Waimea, HI 96796Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

3326 160th Ave SE
Bellevue, WA 98008

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Regency Pacific Management LLC Organization, Bellevue, WA LLC, Management services company, For-profit Operational/Managerial Control Apr 1, 2010 100%
James Lee Clay Individual 5% Or Greater Direct Ownership Interest Apr 25, 2003 100%
Marvin B Beddoe Individual Operational/Managerial ControlCeo of Regency Pacific Managemen Apr 1, 2010 100%
Brandi K Hori-Moises Individual Corporate DirectorAdministrator Nov 1, 2017 100%

Facilities with the same owner 19

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

View all 19

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": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678233600000",
    "number": "1689618308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3326 160TH AVE SE",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980086418",
            "telephone_number": "425-392-4066",
            "fax_number": "425-623-1517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9611 WAENA ROAD",
            "city": "KAUAI",
            "state": "HI",
            "postal_code": "96796",
            "telephone_number": "808-338-1681",
            "fax_number": "808-338-1297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAUAI CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-08",
        "status": "A",
        "authorized_official_last_name": "BEDDOE",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-392-4066"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0-03831-1",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.