Healthcare Provider Details

I. General information

NPI: 1437194347
Provider Name (Legal Business Name): PACIFIC RENAL CARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 HOOHANA ST SUITE 201
KAHULUI HI
96732-2476
US

IV. Provider business mailing address

2226 LILIHA ST SUITE 226
HONOLULU HI
96817-1600
US

V. Phone/Fax

Practice location:
  • Phone: 808-873-2121
  • Fax: 808-873-2148
Mailing address:
  • Phone: 808-585-4620
  • Fax: 808-585-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURA K.M. COLBERT
Title or Position: EXEUCTIVE DIRECTOR
Credential:
Phone: 808-585-4620