1124009584 NPI number — QUEENS NORTH HAWAII COMMUNITY HOSPITAL

Table of content: (NPI 1124009584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124009584 NPI number — QUEENS NORTH HAWAII COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUEENS NORTH HAWAII COMMUNITY HOSPITAL
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:
KOHALA HOME HEALTH CARE OF NORTH HAWAII COMMUNITY HOSPITAL, INC.
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:
1124009584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2799
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAMUELA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96743-2799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-881-4400
Provider Business Mailing Address Fax Number:
808-881-4404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67-1125 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-8496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-881-4400
Provider Business Practice Location Address Fax Number:
808-881-4404
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ATWAL
Authorized Official First Name:
MONEY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
DIRECTOR OF FINANCE & IT
Authorized Official Telephone Number:
808-881-4409

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA 25 , 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)





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