NPIMap

Organization Active NPI

Lanai Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Lanai City, HI
National Provider Identifier
1679754097
Registry record updated May 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LANAI COMMUNITY HEALTH CENTER
Practice address
333 Sixth St
Lanai City, HI 96763
Phone
(808) 565-6919
NPI assigned
Nov 15, 2007
Last updated
May 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2026

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

Authorized official

Name
Jacey G Laborte
Title
Chief Executive Officer
Phone
(808) 649-5407

Specialties & licenses 1

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

Addresses

Primary practice location

333 Sixth St
Lanai City, HI 96763

Mailing address

PO Box 630142
PO Box 630142
Lanai City, HI 96763-0142
Phone (808) 565-6919

Other identifiers 2

IdentifierTypeStateIssuer
121854MedicaidHI
509596MedicaidHI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120629000093 HI Part B Supplier - Clinic/Group Practice 5395828925 Receives reassigned benefits from 12 practitioners
Practice locations: Lanai City, HI
O20150224000970 HI Part A Provider - Federally Qualified Health Center (FQHC) 5395828925 Practice locations: Lanai City, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679754097. Details of each certification follow.

Federally qualified health center certification: CCN 121854

Legal name
LANAI COMMUNITY HEALTH CENTER
Organization structure
CorporationNon-profit
Incorporated
Nov 29, 2004 in HI
Enrollment address
333 Sixth St
Lanai City, HI 96763-0000

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Andrew Dela Cruz Individual Corporate Director Jan 1, 2014
Donovan Ozoa Individual Corporate Director Jan 1, 2014
Michele Holsomback Individual Corporate Director Jan 1, 2014
Beverly Zigmon Individual Corporate Director Jan 2, 2008
Jennifer Montgomery Individual Corporate Director Jan 1, 2014
Diana Shaw Individual W-2 Managing Employee Nov 1, 2008
Jacqueline Woosley Individual Corporate Director Jan 2, 2008
Deborah Dela Cruz Individual Corporate Director Jan 2, 2008
Aaron Fernandez Individual Corporate Director Oct 1, 2013

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778198400000",
    "number": "1679754097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 630142",
            "address_2": "PO BOX 630142",
            "city": "LANAI CITY",
            "state": "HI",
            "postal_code": "967630142",
            "telephone_number": "808-565-6919",
            "fax_number": "808-565-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 SIXTH ST",
            "city": "LANAI CITY",
            "state": "HI",
            "postal_code": "96763",
            "telephone_number": "808-565-6919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANAI COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2026-05-08",
        "certification_date": "2026-05-08",
        "status": "A",
        "authorized_official_last_name": "LABORTE",
        "authorized_official_first_name": "JACEY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "808-649-5407"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121854",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "509596",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lanai City, HI

Sources for this page

Verify at the official NPI Registry.