Provider Demographics
NPI:1063833655
Name:KO OLAULOA HEALTH CENTER
Entity Type:Organization
Organization Name:KO OLAULOA HEALTH CENTER
Other - Org Name:KO'OLAULOA COMMUNITY HEALTH AND WELLNESS CENTER, HAUULA MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ARATANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-792-3840
Mailing Address - Street 1:P.O. BOX 395
Mailing Address - Street 2:
Mailing Address - City:KAHUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96731
Mailing Address - Country:US
Mailing Address - Phone:808-293-9216
Mailing Address - Fax:808-293-5390
Practice Address - Street 1:54-316 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:HAUULA
Practice Address - State:HI
Practice Address - Zip Code:96717
Practice Address - Country:US
Practice Address - Phone:808-293-9216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KO'OLAULOA HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-27
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI121842OtherPTAN