Provider Demographics
NPI:1487267811
Name:SLEEP CENTER HAWAII LLC
Entity type:Organization
Organization Name:SLEEP CENTER HAWAII LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-456-7378
Mailing Address - Street 1:75-167 KALANI ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1800
Mailing Address - Country:US
Mailing Address - Phone:808-327-6669
Mailing Address - Fax:808-327-4506
Practice Address - Street 1:75-167 KALANI ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1800
Practice Address - Country:US
Practice Address - Phone:808-327-6669
Practice Address - Fax:808-327-4506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLEEP CENTER HAWAII LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty