Provider Demographics
NPI:1891098513
Name:HOOLA LAHUI HAWAII
Entity Type:Organization
Organization Name:HOOLA LAHUI HAWAII
Other - Org Name:KAUAI COMMUNITY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-240-0100
Mailing Address - Street 1:PO BOX 3990
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-6990
Mailing Address - Country:US
Mailing Address - Phone:808-240-0100
Mailing Address - Fax:808-245-4146
Practice Address - Street 1:4800 KAWAIHAU RD STE D
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1964
Practice Address - Country:US
Practice Address - Phone:808-240-0140
Practice Address - Fax:808-245-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI121821Medicare Oscar/Certification