NPIMap

Organization Active NPI

Hale Kupuna Heritage Home, LLC

  • Nursing Facility/Intermediate Care Facility
  • Koloa, HI
National Provider Identifier
1992792733
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
61-N Issued in HI
Legal business name
HALE KUPUNA HERITAGE HOME, LLC
Practice address
4297C Omao Rd
Koloa, HI 96756-9624
Phone
(808) 742-7591
Fax
(808) 742-6563
NPI assigned
Oct 5, 2005
Last updated
Oct 3, 2022By the provider in NPPES
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
Cfo
Phone
(808) 247-0003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 61-N HI Primary

Addresses

Primary practice location

4297C Omao Rd
Koloa, HI 96756-9624

Mailing address

45-181 Waikalua Rd
Kaneohe, HI 96744-2765
Phone (808) 247-0003

Other identifiers 1

IdentifierTypeStateIssuer
521030-01MedicaidHI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110323000349 HI Part A Provider - Skilled Nursing Facility 7315120755 Practice locations: Koloa, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992792733. Details of each certification follow.

Skilled nursing facility certification: CCN 125062

Legal name
HALE KUPUNA HERITAGE HOME, LLC
Doing business as
OHANA PACIFIC HEALTH
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 7, 2011
Last certification
Sep 6, 2024
Beds
84
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Ohana Pacific Management Company, Inc
Organization structure
LLCProprietary
Incorporated
Oct 16, 2001 in HI
Enrollment address
4297A Omao Rd
Koloa, HI 96756-9624
Nursing home name
HALE KUPUNA HERITAGE HOME, LLC
Affiliated entity
OHANA PACIFIC MANAGEMENT CO.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Hale Kupuna Heritage Home, LLCCCN 125062 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 7, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8445.3 residents per day on average
Chain
Ohana Pacific Management Co.6 facilities in the chain
Penalties (3 years)
1Fines totaling $10,628

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
12D0697252Hale Kupuna Heritage Home4297A Omao Rd, Koloa, HI 96756Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: koloa.hale.kupuna.heritage.home@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
Lea Ukauka Individual Adp of the SNF Aug 18, 2021
Richard S. Kishaba 2010 Dynasty Trust Organization, Kaneohe, HI 5% Or Greater Indirect Ownership Interest Jul 30, 2010 90%
Joel Gregory Smith Individual Operational/Managerial Control Dec 1, 2025
Adp of the SNF Dec 1, 2025
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 Nov 12, 2009 100%
Operational/Managerial Control Nov 12, 2009
Adp of the SNF Dec 16, 2025
Randall I Hata Individual Operational/Managerial Control Nov 12, 2009
Adp of the SNF Nov 12, 2009
Richard S Kishaba Individual 5% Or Greater Indirect Ownership Interest Nov 12, 2009 10%
Operational/Managerial Control Nov 12, 2009
Adp of the SNF Nov 12, 2009
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
Arnold WH Kop Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Blossom Luana Ukaukau Individual Adp of the SNF Aug 18, 2021
Suanne Morikuni Individual Corporate OfficerChief Financial Officer Jan 1, 2015
Operational/Managerial Control Jan 1, 2015
Adp of the SNF Jan 1, 2015

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 3

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.

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": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1992792733",
    "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": "808-247-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4297C OMAO RD",
            "city": "KOLOA",
            "state": "HI",
            "postal_code": "967569624",
            "telephone_number": "808-742-7591",
            "fax_number": "808-742-6563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALE KUPUNA HERITAGE HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "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": "CFO",
        "authorized_official_telephone_number": "808-247-0003"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "HI",
            "license": "61-N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "521030-01",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Koloa, HI

Sources for this page

Verify at the official NPI Registry.