1649782517 NPI number — KAUAI INDEPENDENT REHABILITATION ASSOCIATES, LLC

Table of content: (NPI 1649782517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649782517 NPI number — KAUAI INDEPENDENT REHABILITATION ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAUAI INDEPENDENT REHABILITATION ASSOCIATES, LLC
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:
OHANA SPORTS MEDICINE
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:
1649782517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2-2488 KAUMUALII HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAHEO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96741-8311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-335-5808
Provider Business Mailing Address Fax Number:
808-335-5657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4-901 KUHIO HWY STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96746-1549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-826-6000
Provider Business Practice Location Address Fax Number:
844-965-9830
Provider Enumeration Date:
10/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
RHOADES
Authorized Official First Name:
RONNIE
Authorized Official Middle Name:
V
Authorized Official Title or Position:
BILLING OFFICE MANAGER
Authorized Official Telephone Number:
808-977-8241

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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