Healthcare Provider Details

I. General information

NPI: 1356423974
Provider Name (Legal Business Name): LANAI COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 SEVENTH STREET
LANAI HI
96763
US

IV. Provider business mailing address

628 SEVENTH STREET
LANAI HI
96763
US

V. Phone/Fax

Practice location:
  • Phone: 808-565-6411
  • Fax:
Mailing address:
  • Phone: 808-565-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number43-N
License Number StateHI

VIII. Authorized Official

Name: MR. JOHN SCHAUMBURG
Title or Position: ADMINISTRAITOR
Credential:
Phone: 808-565-6411