Provider Demographics
NPI:1992176283
Name:THE WAHIAWA CENTER FOR COMMUNITY HEALTH
Entity type:Organization
Organization Name:THE WAHIAWA CENTER FOR COMMUNITY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEV
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-622-1618
Mailing Address - Street 1:302 CALIFORNIA AVENUE
Mailing Address - Street 2:STE #106
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786
Mailing Address - Country:US
Mailing Address - Phone:808-622-1618
Mailing Address - Fax:877-759-6943
Practice Address - Street 1:302 CALIFORNIA AVENUE
Practice Address - Street 2:STE #106
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786
Practice Address - Country:US
Practice Address - Phone:808-622-1618
Practice Address - Fax:877-759-6943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
HI261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty