Provider Demographics
NPI:1609045673
Name:WAHIAWA GENERAL HOSPITAL
Entity Type:Organization
Organization Name:WAHIAWA GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-621-8411
Mailing Address - Street 1:128 LEHUA ST
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2036
Mailing Address - Country:US
Mailing Address - Phone:808-621-8411
Mailing Address - Fax:808-621-4117
Practice Address - Street 1:128 LEHUA ST
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2036
Practice Address - Country:US
Practice Address - Phone:808-621-8411
Practice Address - Fax:808-621-4117
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAHIAWA GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9-H332B00000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0425680001Medicare NSC