Provider Demographics
NPI:1053955120
Name:WHCHC - HAWAII ISLAND COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:WHCHC - HAWAII ISLAND COMMUNITY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-326-3878
Mailing Address - Street 1:75-5751 KUAKINI HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1753
Mailing Address - Country:US
Mailing Address - Phone:808-961-4071
Mailing Address - Fax:808-961-5678
Practice Address - Street 1:450 KILAUEA AVE STE 105
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3089
Practice Address - Country:US
Practice Address - Phone:808-961-4071
Practice Address - Fax:808-961-5678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)