Provider Demographics
NPI:1093868416
Name:HAMAKUA HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:HAMAKUA HEALTH CENTER, INC.
Other - Org Name:HAMAKUA KOHALA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-775-7204
Mailing Address - Street 1:45-549 PLUMERIA ST
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-6902
Mailing Address - Country:US
Mailing Address - Phone:808-775-7204
Mailing Address - Fax:808-775-9404
Practice Address - Street 1:53-3925 AKONI PULE HWY
Practice Address - Street 2:KOHALA FAMILY HEALTH CENTER
Practice Address - City:KAPA'AU
Practice Address - State:HI
Practice Address - Zip Code:96755
Practice Address - Country:US
Practice Address - Phone:808-889-6236
Practice Address - Fax:808-889-0107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAMAKUA HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51864901Medicaid
HI51864901Medicaid
HI121830Medicare Oscar/Certification