| Organization Name: | KOOLAULOA COMMUNITY HEALTH AND WELLNESS CENTER, INC. |
| NPI Number: | 1528026952 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BENJAMIN F PETTUS (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 56-119 Pualalea St. Kahuku |
| State: | HI US |
| Postal Code: | 96731 |
| Phone Number: | 8082939216 |
| Fax Number: | 8082935390 |
| NPI Enumeration Date: | 05/03/2006 |
| NPI Last Update Date: | 11/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251V00000X |
| License Number: | 440-=========F-01 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Voluntary or Charitable |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |