Provider Demographics
NPI:1518935162
Name:HAWAIIAN REHABILITATION SERVICES INC
Entity Type:Organization
Organization Name:HAWAIIAN REHABILITATION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-329-0591
Mailing Address - Street 1:75-165 HUALALAI RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA-KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1742
Mailing Address - Country:US
Mailing Address - Phone:808-329-0591
Mailing Address - Fax:808-329-2066
Practice Address - Street 1:75-165 HUALALAI RD
Practice Address - Street 2:
Practice Address - City:KAILUA-KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1742
Practice Address - Country:US
Practice Address - Phone:808-329-0591
Practice Address - Fax:808-329-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52510701Medicaid
HI001729Medicaid