Provider Demographics
NPI:1386853851
Name:PACIFIC RENAL CARE FOUNDATION
Entity Type:Organization
Organization Name:PACIFIC RENAL CARE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-585-4620
Mailing Address - Street 1:203 HOOHANA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:203 HOOHANA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2476
Practice Address - Country:US
Practice Address - Phone:808-893-2532
Practice Address - Fax:808-893-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-813163WN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WN0300XNursing Service ProvidersRegistered NurseNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI813OtherAPRN LICENSE