Provider Demographics
NPI:1619974375
Name:KAHUKU HOSPITAL
Entity Type:Organization
Organization Name:KAHUKU HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAIOLETI
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LSW
Authorized Official - Phone:808-293-9221
Mailing Address - Street 1:56-117 PUALALEA ST
Mailing Address - Street 2:
Mailing Address - City:KAHUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96731-2052
Mailing Address - Country:US
Mailing Address - Phone:808-293-9221
Mailing Address - Fax:808-232-0197
Practice Address - Street 1:56-117 PUALALEA ST
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731-2052
Practice Address - Country:US
Practice Address - Phone:808-293-9221
Practice Address - Fax:808-232-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12-H282NC0060X
HI42N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI508137Medicaid
HI=========OtherTAX ID AND OTHER INSURANC
HI508137Medicaid
HI121304Medicare Oscar/Certification
HI=========OtherTAX ID AND OTHER INSURANC