1104874619 NPI number — WEST HAWAII COMMUNITY HEALTH CENTER, INC.

Table of content: (NPI 1104874619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104874619 NPI number — WEST HAWAII COMMUNITY HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST HAWAII COMMUNITY HEALTH CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KEA'AU FAMILY HEALTH AND DENTAL
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104874619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75-5751 KUAKINI HWY STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAILUA KONA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96740-1753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-326-5629
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16-192 PILI MUA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEAAU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96749-8134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-930-0400
Provider Business Practice Location Address Fax Number:
808-961-5678
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAAFFE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
808-326-3884

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 592528 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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