NPIMap

Organization Active NPI

Waianae District Comprehensive Health and Hospital Board, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Waianae, HI
National Provider Identifier
1245052893
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED
Practice address
89-153 Mano Ave
Waianae, HI 96792-4036
Phone
(808) 697-3300
NPI assigned
Oct 25, 2024
Organization subpart
Yes
Parent organization
WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cindy Yee
Title
Chief Financial Officer
Phone
(808) 697-3128

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

89-153 Mano Ave
Waianae, HI 96792-4036

Mailing address

86-260 Farrington Hwy
Waianae, HI 96792-3128
Phone (808) 697-3300

Other names 1

  • Nanaikapono Elementary School School-Based Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241217004280 HI Part A Provider - Federally Qualified Health Center (FQHC) 9931008349 Practice locations: Waianae, HI

Federally qualified health center certification: CCN 121016

Legal name
WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD INCORPORATED
Doing business as
NANAIKAPONO ELEMENTARY SCHOOL SCHOOL-BASED HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 17, 2024
Last certification
Dec 17, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
89-153 Mano Ave
Waianae, HI 96792-4036

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Waianae Coast Comp H39 organizations share this tax ID, including this one
Part of
Waianae Coast Comp H

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Ownership & related parties

All disclosed owners & managing parties 21

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Genevieve Aken Individual Other May 19, 2020
Dane K Lloyd Individual Other May 5, 2012
Charles Hew-Len Individual Other May 18, 2015
Clifford K Isara Individual Other Nov 15, 2007
Desire de Soto Individual Other May 21, 2024
Richard P Bettini Individual W-2 Managing EmployeeChief Executive Officer Jul 1, 1993
Other Jul 1, 1993
Marianne Glushenko Individual Other May 21, 2024
Lajuaine C Suiso Individual Other May 5, 2012
Merrie L Aipoalani Individual Other Nov 15, 2007
Denice Keliikoa Individual Other May 18, 2015
Deroy Lavatai Individual Other May 16, 2023
Anthony Paris Individual Other Apr 20, 2021
Billie J Hauge Individual Other Mar 17, 2014
Tesha Malama Individual Other May 17, 2022
Judith Babson Individual Other May 21, 2018
Todd Nitta Individual Other Jul 25, 2023
Virginia M Fuata Individual Other Nov 15, 2007
Renee J Rego Individual Other May 20, 2010
Florine D Pell Individual Other May 18, 2015
Wayne K Suehiro Individual Other Nov 15, 2007
Daniel H Gomes Individual Other Nov 15, 2007

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Comp at Tamura Super MarketWaianae, HI, CCN 121878 Federally qualified health center Operational/Managerial Control May 6, 1969
Makaha HealthWaianae, HI, CCN 121021 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1972

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730851200000",
    "number": "1245052893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86-260 FARRINGTON HWY",
            "city": "WAIANAE",
            "state": "HI",
            "postal_code": "967923128",
            "telephone_number": "808-697-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89-153 MANO AVE",
            "city": "WAIANAE",
            "state": "HI",
            "postal_code": "967924036",
            "telephone_number": "808-697-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED",
        "enumeration_date": "2024-10-25",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A",
        "authorized_official_last_name": "YEE",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "808-697-3128"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nanaikapono Elementary School School-Based Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waianae, HI

Sources for this page

Verify at the official NPI Registry.