Provider Demographics
NPI:1205413101
Name:LANAI COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:LANAI COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:M V
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-565-6919
Mailing Address - Street 1:PO BOX 630142
Mailing Address - Street 2:
Mailing Address - City:LANAI CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96763-0142
Mailing Address - Country:US
Mailing Address - Phone:808-565-6919
Mailing Address - Fax:
Practice Address - Street 1:333 SIXTH STREET
Practice Address - Street 2:
Practice Address - City:LANAI CITY
Practice Address - State:HI
Practice Address - Zip Code:96763-0142
Practice Address - Country:US
Practice Address - Phone:808-565-6919
Practice Address - Fax:808-565-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI614330Medicaid