Provider Demographics
NPI:1851676746
Name:WEST HAWAII COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:WEST HAWAII COMMUNITY HEALTH CENTER, INC.
Other - Org Name:HAWAII ISLAND COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-326-3884
Mailing Address - Street 1:75-5751 KUAKINI HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1753
Mailing Address - Country:US
Mailing Address - Phone:808-756-2927
Mailing Address - Fax:
Practice Address - Street 1:1257 KILAUEA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4205
Practice Address - Country:US
Practice Address - Phone:808-333-3600
Practice Address - Fax:808-961-5678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI696734Medicaid