Provider Demographics
NPI:1972230530
Name:MALAMA MOLOKAI HEALTH, LTD
Entity Type:Organization
Organization Name:MALAMA MOLOKAI HEALTH, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-650-2339
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-0398
Mailing Address - Country:US
Mailing Address - Phone:808-553-4638
Mailing Address - Fax:
Practice Address - Street 1:107B ALA MALAMA ST
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748
Practice Address - Country:US
Practice Address - Phone:808-553-4368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty