Healthcare Provider Details

I. General information

NPI: 1417413576
Provider Name (Legal Business Name): KAUAI COMMUNITY HEALTH ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 OKA ST STE B
KILAUEA HI
96754-5332
US

IV. Provider business mailing address

2460 OKA ST STE 101A
KILAUEA HI
96754-5308
US

V. Phone/Fax

Practice location:
  • Phone: 808-828-0030
  • Fax: 808-977-7769
Mailing address:
  • Phone: 808-977-7767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: LA REINA NEBRE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 808-828-2885