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General NPI Number Information
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NPI Number | 1780738005
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Entity Type | Organization
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Legal Business Name | WAIMANALO HEALTH CENTER
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 41-1347 KALANIANAOLE HWY
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City | WAIMANALO
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State | HI
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Zip | 96795-1247
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Country | US
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Telephone | 808-954-7107
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Fax | 808-259-6449
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Provider Business Mailing Address
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Address Line | 41-1347 KALANIANAOLE HWY
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City | WAIMANALO
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State | HI
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Zip | 96795-1247
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Country | US
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Telephone | 808-954-7107
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Fax | 808-259-6449
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. MARY ONEHA
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Credential | APRN, PHD, FAAN
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Telephone | 808-954-7107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | W20416724-01
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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