Provider Demographics
NPI:1215359989
Name:FIVE MOUNTAINS HAWAII, INC
Entity Type:Organization
Organization Name:FIVE MOUNTAINS HAWAII, INC
Other - Org Name:KIPUKA O KE OLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CLAREN
Authorized Official - Middle Name:KUULEI
Authorized Official - Last Name:KEALOHA-BEAUDET
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-885-5900
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-0818
Mailing Address - Country:US
Mailing Address - Phone:808-885-5900
Mailing Address - Fax:808-885-6900
Practice Address - Street 1:64-1035 MAMALAHO HWY STE F
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8440
Practice Address - Country:US
Practice Address - Phone:808-885-5900
Practice Address - Fax:808-885-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI813669Medicaid