Healthcare Provider Details

I. General information

NPI: 1073372025
Provider Name (Legal Business Name): INTERNATIONAL RIVER OF LIFE CHRISTIAN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87-728 FARRINGTON HWY
WAIANAE HI
96792-3271
US

IV. Provider business mailing address

85-576 WAIANAE VALLEY RD
WAIANAE HI
96792-2637
US

V. Phone/Fax

Practice location:
  • Phone: 808-375-7504
  • Fax:
Mailing address:
  • Phone: 808-375-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA L EVERETT
Title or Position: PASTOR
Credential:
Phone: 808-375-7504