Provider Demographics
NPI:1083221204
Name:ALPHA CARE HAWAII LLC
Entity Type:Organization
Organization Name:ALPHA CARE HAWAII LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-961-1929
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-0813
Mailing Address - Country:US
Mailing Address - Phone:808-961-1929
Mailing Address - Fax:808-961-1928
Practice Address - Street 1:1289 KILAUEA AVE STE E
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4251
Practice Address - Country:US
Practice Address - Phone:808-961-1929
Practice Address - Fax:808-961-1928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care