Healthcare Provider Details

I. General information

NPI: 1003905092
Provider Name (Legal Business Name): KULA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KEOKEA PL
KULA HI
96790-7450
US

IV. Provider business mailing address

100 KEOKEA PL
KULA HI
96790-7450
US

V. Phone/Fax

Practice location:
  • Phone: 808-878-1221
  • Fax: 808-876-4438
Mailing address:
  • Phone: 808-878-1221
  • Fax: 808-876-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberOHCA 25-H
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberOHCA25-H
License Number StateHI

VIII. Authorized Official

Name: MRS. NERISSA GAYLE GARRITY
Title or Position: BUSINESS MANAGER
Credential: MBA
Phone: 808-876-4341