| Organization Name: | LIBERTY DIALYSIS HAWAII LLC |
| NPI Number: | 1487037206 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MELISSA-ANN SOUZA (DIRECTOR OF OPERATIONS) |
| Mailing Address: | 10 Hoohui Rd Ste 100 Lahaina |
| State: | HI US |
| Postal Code: | 967619257 |
| Phone Number: | 8086696628 |
| Fax Number: | 8086691272 |
| NPI Enumeration Date: | 06/30/2015 |
| NPI Last Update Date: | 06/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | 1060527 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |