Basic Information
| Provider Information | |||||||||
| NPI: | 1649520644 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST HAWAII COMMUNITY HEALTH CENTER, INC. | ||||||||
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| OtherOrganizationName: | WEST HAWAII CUMMUNITY HEALTH CENTER, INC. - WAIKOLOA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75-5751 KUAKINI HWY | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967401753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083263883 | ||||||||
| FaxNumber: | 8083299370 | ||||||||
| Practice Location | |||||||||
| Address1: | 68-1845 WAIKOLOA ROAD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | WAIKOLOA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967385581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083263883 | ||||||||
| FaxNumber: | 8083299370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2012 | ||||||||
| LastUpdateDate: | 01/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | TAAFFE | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8083263883 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WEST HAWAII COMMUNITY HEALTH CENTER, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.