1922336791 NPI number — HIILANI HEALTH CORPORATION

Table of content: (NPI 1922336791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922336791 NPI number — HIILANI HEALTH CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIILANI HEALTH CORPORATION
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:
LIFE CONNECTIONS, INC.
Provider Other Organization Name Type Code:
4
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:
1922336791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 860327
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAHIAWA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96786-0327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-800-7326
Provider Business Mailing Address Fax Number:
808-621-0639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 OLOKANI PL
Provider Second Line Business Practice Location Address:
2ND FL
Provider Business Practice Location Address City Name:
WAHIAWA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96786-4812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-621-2670
Provider Business Practice Location Address Fax Number:
808-621-0639
Provider Enumeration Date:
12/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAYMUNDO
Authorized Official First Name:
JAY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/SECRETARY
Authorized Official Telephone Number:
808-800-7326

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 639007 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".