12D2092355 CLIA NUMBER - LILIHA KUPUNA SNF LLC DBA CLARENCE TC CHING VILLAS

Laboratory Demographics

  • CLIA Code: 12D2092355
  • Facility Name: LILIHA KUPUNA SNF LLC DBA CLARENCE TC CHING VILLAS
  • Facility Address: 2230 LILIHA ST SUITE 108
    HONOLULU, HI
    ZIP 96817
  • Facility Phone: 808 547-6000
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DUSTY DAVIS
  • NPI Number: 1164815338
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 12D2092355
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name LILIHA KUPUNA SNF LLC DBA CLARENCE TC CHING VILLAS
Street 2230 LILIHA ST SUITE 108
City HONOLULU
State HI
ZIP 96817
Phone 808 547-6000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2025
Certificate Expiration Date 3/2/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director DUSTY DAVIS

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This page was last updated on: 9/29/2025