=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619888732
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE WAHIAWA CENTER FOR COMMUNITY HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2026
-----------------------------------------------------
Last Update Date | 09/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 67-272 GOODALE AVE
-----------------------------------------------------
City | WAIALUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-622-1618
-----------------------------------------------------
Fax | 877-759-6943
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 CALIFORNIA AVE STE 106
-----------------------------------------------------
City | WAHIAWA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96786-1841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-622-1618
-----------------------------------------------------
Fax | 877-759-6943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BEVERLY W HARBIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-343-4509
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------