Provider Demographics
NPI:1457412066
Name:KOHALA HOSPITAL
Entity Type:Organization
Organization Name:KOHALA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GINO
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-889-6211
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:KAPAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96755-0010
Mailing Address - Country:US
Mailing Address - Phone:808-889-6211
Mailing Address - Fax:808-889-6978
Practice Address - Street 1:54 383 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:KAPAAU
Practice Address - State:HI
Practice Address - Zip Code:96755
Practice Address - Country:US
Practice Address - Phone:808-889-6211
Practice Address - Fax:808-889-6978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI26N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00006148Medicaid
HI00006148Medicaid