Provider Demographics
NPI:1033190319
Name:NORTH HAWAII COMMUNITY HOSPITAL, INC.
Entity Type:Organization
Organization Name:NORTH HAWAII COMMUNITY HOSPITAL, INC.
Other - Org Name:NORTH HAWAII COMMUNITY HOSPITAL DIALYSIS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-881-4400
Mailing Address - Street 1:PO BOX 2799
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-2799
Mailing Address - Country:US
Mailing Address - Phone:808-881-4400
Mailing Address - Fax:808-881-4404
Practice Address - Street 1:67-1125 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8496
Practice Address - Country:US
Practice Address - Phone:808-881-4400
Practice Address - Fax:808-881-4404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH HAWAII COMMUNITY HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-14
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI39H261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI122302Medicare Oscar/Certification