Provider Demographics
NPI:1124009584
Name:QUEENS NORTH HAWAII COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:QUEENS NORTH HAWAII COMMUNITY HOSPITAL
Other - Org Name:KOHALA HOME HEALTH CARE OF NORTH HAWAII COMMUNITY HOSPITAL, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE & IT
Authorized Official - Prefix:
Authorized Official - First Name:MONEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ATWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-881-4409
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHHA 25251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI127019Medicare Oscar/Certification