State of Hawaii Department of Health
Organization Active NPI Community/Behavioral Health Agency · Wailuku, HI
NPI 1295918183 · NPPES record last updated Jun 18, 2014
Key facts
- NPI
- 1295918183
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- STATE OF HAWAII DEPARTMENT OF HEALTH
- Practice address
- 121 Mahalani St
Wailuku, HI 96793 - Phone
- (808) 984-2150
- NPI assigned
- Dec 13, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- STATE OF HAWAII DEPARTMENT OF HEALTH
Authorized official
- Name
- Raquel B. Nakahara
- Title
- Financial Resource Specialist
- Phone
- (808) 590-7320
Other NPIs on the same Medicare enrollment 23
Corporate family (same tax ID) 24
Practitioners 2
-
Giavanna Lau, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in HI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040127000902 | HI | Part B Supplier - Clinic/Group Practice | 5395648539 |
Receives reassigned benefits from 23 practitioners 23 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kealakekua, HI; Lahaina, HI; Lanai City, HI; Kaneohe, HI; Lihue, HI; Naalehu, HI; Pahoa, HI; Pearl City, HI… |
National Provider Directory
- Tax ID family
- Hawaii County Comm HLTH
- Part of
- Hawaii County Comm HLTH
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
121 Mahalani St
Wailuku, HI 96793
Mailing address
1250 Punchbowl St
RM 256
Honolulu, HI 96813-2416
Phone (808) 590-7320
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 53937204 | Medicaid | HI |
Other names
- Maui Community Mental Health Center-Wailuku
Other providers in Wailuku, HI
- Spencer Micahel Spencer-Perieff
- Stuart Henry Spielman
- St. Francis Medical Center - Maui Dialysis
- Joseph J Stafford III
- Randy W Stark
- State of Hawaii Department of Health
- Mia C Stclair
- Steadfast Physical Therapy, Inc.
- Steve E Clark MD Thelma M Yamada MD LLC
- Monica Stevens
All providers in Wailuku, HI · Community/Behavioral Health Agency in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.