Provider Demographics
NPI:1043362338
Name:WAIANAE COAST COMMUNITY MENTAL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:WAIANAE COAST COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:POHAOKALANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SONODA-BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, ESQ
Authorized Official - Phone:808-696-4211
Mailing Address - Street 1:86-226 FARRINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3128
Mailing Address - Country:US
Mailing Address - Phone:808-696-4211
Mailing Address - Fax:808-696-5516
Practice Address - Street 1:86-226 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3128
Practice Address - Country:US
Practice Address - Phone:808-696-4211
Practice Address - Fax:808-696-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1952865305Medicaid
HI1366594616Medicaid
HI1699216556Medicaid
HI1831500016Medicaid