Healthcare Provider Details

I. General information

NPI: 1831153410
Provider Name (Legal Business Name): WAHIAWA GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 LEHUA ST
WAHIAWA HI
96786-2036
US

IV. Provider business mailing address

128 LEHUA ST
WAHIAWA HI
96786-2036
US

V. Phone/Fax

Practice location:
  • Phone: 808-621-8411
  • Fax:
Mailing address:
  • Phone: 808-621-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA-32
License Number StateHI

VIII. Authorized Official

Name: MR. ROBERT D. OLDEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 808-621-8411