Provider Demographics
NPI:1639257793
Name:KULA HOSPITAL
Entity Type:Organization
Organization Name:KULA HOSPITAL
Other - Org Name:KULA HOSPITAL SWING
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NERISSA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:GARRITY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:808-876-4341
Mailing Address - Street 1:100 KEOKEA PL
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-7450
Mailing Address - Country:US
Mailing Address - Phone:808-878-1221
Mailing Address - Fax:808-876-4438
Practice Address - Street 1:100 KEOKEA PL
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-7450
Practice Address - Country:US
Practice Address - Phone:808-878-1221
Practice Address - Fax:808-876-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOHCA 25-H275N00000X
HIOHCA25-H275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI592297Medicaid
HI12-Z308Medicare UPIN
HI12Z308Medicare Oscar/Certification