Healthcare Provider Details

I. General information

NPI: 1124299136
Provider Name (Legal Business Name): WAIANAE COAST COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date: 10/13/2020
Reactivation Date: 08/29/2024

III. Provider practice location address

86-226 FARRINGTON HWY
WAIANAE HI
96792-3128
US

IV. Provider business mailing address

86-226 FARRINGTON HWY
WAIANAE HI
96792-3128
US

V. Phone/Fax

Practice location:
  • Phone: 808-696-4211
  • Fax: 808-696-5516
Mailing address:
  • Phone: 808-696-4211
  • Fax: 808-696-5516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. POHAOKALANI SONODA-BURGESS
Title or Position: EXECUTIVE DIRECTOR
Credential: ESQ, LSW
Phone: 808-696-4211