Provider Demographics
NPI:1417413576
Name:KAUAI COMMUNITY HEALTH ALLIANCE
Entity Type:Organization
Organization Name:KAUAI COMMUNITY HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LA REINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEBRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-828-2885
Mailing Address - Street 1:2460 OKA ST STE 101A
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-5308
Mailing Address - Country:US
Mailing Address - Phone:808-977-7767
Mailing Address - Fax:
Practice Address - Street 1:2430 OKA ST STE B
Practice Address - Street 2:
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754-5332
Practice Address - Country:US
Practice Address - Phone:808-828-0030
Practice Address - Fax:808-977-7769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)