Provider Demographics
NPI:1629032164
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAHIAWA GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9-H273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0020OtherTRICARE PYSCH ID
HI0049036801Medicaid
HI0020OtherTRICARE PYSCH ID
HI12S004Medicare ID - Type UnspecifiedMEDICARE PYSCH ID