=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356668313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. FRANCIS LILIHA LIVER CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2010
-----------------------------------------------------
Last Update Date | 04/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2230 LILIHA ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-1646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-547-8001
-----------------------------------------------------
Fax | 808-547-8018
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2226 LILIHA ST SUITE 227
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-547-8001
-----------------------------------------------------
Fax | 808-547-8018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ADMINISTRATOR
-----------------------------------------------------
Name | JERRY CORREA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-547-8004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | TO BE APPLIED FOR
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------