Provider Demographics
NPI:1568645109
Name:STATE OF HAWAII DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:STATE OF HAWAII DEPARTMENT OF HEALTH
Other - Org Name:SAMUEL MAHELONA HOSPITAL- PROFESSIONAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCIAL RESOURCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:NAKAHARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-590-7320
Mailing Address - Street 1:1250 PUNCHBOWL ST
Mailing Address - Street 2:RM 256
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2416
Mailing Address - Country:US
Mailing Address - Phone:808-590-7320
Mailing Address - Fax:808-586-4745
Practice Address - Street 1:4800 KAWAIHAU RD
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1930
Practice Address - Country:US
Practice Address - Phone:808-241-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI53937203Medicaid
HIHKCMHMedicare PIN