Basic Information
| Provider Information | |||||||||
| NPI: | 1831153410 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAHIAWA GENERAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 LEHUA ST | ||||||||
| Address2: | |||||||||
| City: | WAHIAWA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967862036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086218411 | ||||||||
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| Practice Location | |||||||||
| Address1: | 128 LEHUA ST | ||||||||
| Address2: | |||||||||
| City: | WAHIAWA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967862036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086218411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | OLDEN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8086218411 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WAHIAWA GENERAL HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HHA-32 | HI | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 0052020601 | 05 | HI | MEDICAID | 0000 | 01 | HI | TRICARE HOME HEALTH ID | OTHER | 49036801 | 01 | HI | ALOHACARE ID | OTHER |