Healthcare Provider Details

I. General information

NPI: 1619958063
Provider Name (Legal Business Name): CASTLE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ULUKAHIKI ST
KAILUA HI
96734-4454
US

IV. Provider business mailing address

640 ULUKAHIKI ST
KAILUA HI
96734-4454
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-5412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DALE NORTHROP
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 808-263-5142