Provider Demographics
NPI:1033436431
Name:ALOHAWELLNESS CENTER INC
Entity Type:Organization
Organization Name:ALOHAWELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:REQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-531-7878
Mailing Address - Street 1:94-1388 MOANIANI ST STE 203
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-6604
Mailing Address - Country:US
Mailing Address - Phone:808-695-3570
Mailing Address - Fax:808-487-2492
Practice Address - Street 1:94-1388 MOANIANI ST STE 203
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-6604
Practice Address - Country:US
Practice Address - Phone:808-695-3570
Practice Address - Fax:808-487-2492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI346-83261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIW20588240-01OtherHAWAII TAX ID
HIW20588240-02OtherHAWAII TAX ID