Healthcare Provider Details

I. General information

NPI: 1679754097
Provider Name (Legal Business Name): LANAI COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 03/23/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SIXTH ST
LANAI CITY HI
96763
US

IV. Provider business mailing address

PO BOX 630142
LANAI CITY HI
96763-0142
US

V. Phone/Fax

Practice location:
  • Phone: 808-565-6919
  • Fax:
Mailing address:
  • Phone: 808-565-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DIANA M SHAW
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 808-565-6919