Provider Demographics
NPI:1780738005
Name:WAIMANALO HEALTH CENTER
Entity type:Organization
Organization Name:WAIMANALO HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEHA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PHD, FAAN
Authorized Official - Phone:808-954-7107
Mailing Address - Street 1:41-1347 KALANIANAOLE HWY
Mailing Address - Street 2:
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795-1247
Mailing Address - Country:US
Mailing Address - Phone:808-954-7107
Mailing Address - Fax:808-259-6449
Practice Address - Street 1:41-1347 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1247
Practice Address - Country:US
Practice Address - Phone:808-954-7107
Practice Address - Fax:808-259-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW20416724-01261QC1500X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI049587Medicaid
HI00C0238901OtherBLUES - CUMMINGS
HI00D0094351OtherHMSA PPO - BHATTACHARYYA
HI00A0080927OtherBLUES - CHAN
HI00D0094351OtherBLUES - BHATTACHARYYA
HI04958701Medicaid
HI0054794522Medicaid
HI0000212407OtherBLUES - HATAKEYAMA
HI0000228100Medicaid
HI0007253302Medicaid
HI0055795200Medicaid
HI00D0245664OtherHMSA - AGULLANA
HI0006095000Medicaid
HI00D0245664OtherBLUES - AGULLANA
HI0007253302Medicaid
HIA0000228100Medicare ID - Type UnspecifiedALOHACARE - HATAKEYAMA
HI0054794522Medicaid
HI0055795200Medicaid
HI00A0080927OtherBLUES - CHAN