1114036894 NPI number — REHABILITATION HOSPITAL OF THE PACIFIC

Table of content: (NPI 1114036894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114036894 NPI number — REHABILITATION HOSPITAL OF THE PACIFIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION HOSPITAL OF THE PACIFIC
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:
REHAB AT MAUI - KIHEI
Provider Other Organization Name Type Code:
3
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:
1114036894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
226 N KUAKINI ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96817-2421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-531-3511
Provider Business Mailing Address Fax Number:
808-544-3377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 PIIKEA AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
KIHEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96753-8268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-879-5211
Provider Business Practice Location Address Fax Number:
808-879-5213
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORIWAKI
Authorized Official First Name:
SUE ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCE & CFO
Authorized Official Telephone Number:
808-566-3818

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 144692908 . This is a "OWCP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51997801 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00S0208559 . This is a "ALL HMSA PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 96753B001 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".




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