Organization
COMMUNITY CLINIC OF MAUI, INC.
Active
Other names
Malama I Ke Ola Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN VAZ (CHIEF EXECUTIVE OFFICER)
(808) 872-4018
Entity
Organization
Contact information
Practice address
1881 NANI STREET, WAILUKU, HI 96793
(808) 872-4006
(808) 495-0026
Mailing address
1881 NANI STREET, WAILUKU, HI 96793-1811
(808) 871-7772
(808) 872-4029
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071290-01
—
HI
Enumeration date
12/02/2005
Last updated
11/08/2024
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