Provider Demographics
NPI:1023518370
Name:HAWAII NATUROPATHIC RETREAT CENTER, INC.
Entity type:Organization
Organization Name:HAWAII NATUROPATHIC RETREAT CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYLAC
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:808-933-4400
Mailing Address - Street 1:239 HAILI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2928
Mailing Address - Country:US
Mailing Address - Phone:808-933-4400
Mailing Address - Fax:844-965-9821
Practice Address - Street 1:239 HAILI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2928
Practice Address - Country:US
Practice Address - Phone:808-933-4400
Practice Address - Fax:844-965-9821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X, 261QH0100X
HI261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service