Provider Demographics
NPI:1700521499
Name:TRANSFORMATION HEALTH NETWORK
Entity Type:Organization
Organization Name:TRANSFORMATION HEALTH NETWORK
Other - Org Name:ALOHA KONA PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GROUP PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE CARVALHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-365-2297
Mailing Address - Street 1:75-5995 KUAKINI HWY STE 213
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2120
Mailing Address - Country:US
Mailing Address - Phone:808-365-2297
Mailing Address - Fax:808-339-3702
Practice Address - Street 1:75-5995 KUAKINI HWY STE 513
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2124
Practice Address - Country:US
Practice Address - Phone:808-365-2297
Practice Address - Fax:808-339-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care