Healthcare Provider Details

I. General information

NPI: 1205413101
Provider Name (Legal Business Name): LANAI COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SIXTH STREET
LANAI CITY HI
96763-0142
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: 808-565-9111
Mailing address:
  • Phone: 808-565-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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