12D1001774 CLIA NUMBER - KA'U HOSPITAL

Laboratory Demographics

  • CLIA Code: 12D1001774
  • Facility Name: KA'U HOSPITAL
  • Facility Address: 1 KAMANI STREET, BUILDING MAIN HOSPITAL
    PAHALA, HI
    ZIP 96777
  • Facility Phone: 808 932-4390
  • Facility Type: Hospital
  • Facility Type: Waiver
  • Lab Director: ANDRE THERIAULT
  • NPI Number: 1083209258
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 12D1001774
LAB Type Hospital
Facility Name KA'U HOSPITAL
Street 1 KAMANI STREET, BUILDING MAIN HOSPITAL
City PAHALA
State HI
ZIP 96777
Phone 808 932-4390
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/19/2024
Certificate Expiration Date 7/18/2026
Facility Type Hospital
Lab Director ANDRE THERIAULT

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This page was last updated on: 9/29/2025