State of Hawaii Department of Health

Office of Health Care Assurance

Medicare Section

END STAGE RENAL DISEASE (ESRD) PROGRAM

HAWAII:

NUMBER	FACILITY	LOCATION
1	FRESENIUS MEDICAL CARE – ALOHA DIALYSIS CENTER 1520 Liliha Street Honolulu, Hawaii 96817 Mailing Address: 226 North Kuakini Street Honolulu, Hawaii 96817 Ph: (808) 531-1748 Fax: (808) 531-1501 Correspondence Address: Alvin Cecil Regional Vice President Fresenius Medical Care – Hawaii Region Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Alvin Cecil Regional Manager Provider No. 122503	OAHU
2	FRESENIUS MEDICAL CARE – DIALYSIS SERVICES OF KAPOLEI 555 Farrington Highway Kapolei, Hawaii 96707 Ph: (808) 693-8980 Fax: (808) 693-8968 Correspondence Address: Alvin Cecil Regional Vice President Fresenius Medical Care – Hawaii Region Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Avlin Cecil Regional Manager Provider No. 122508	OAHU
3	FRESENIUS MEDICAL CARE – DIALYSIS SERVICES OF PEARLRIDGE 98-1005 Moanalua Road, Suite 420 Aiea, Hawaii 96701 Ph: (808) 440-4800 Fax: (808) 440-4827 Correspondence Address: Alvin Cecil Regional Vice President Fresenius Medical Care – Hawaii Region Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Alvin Cecil Regional Manager Provider No. 122509	OAHU
4	FRESENIUS MEDICAL CARE – HONOLULU DIALYSIS CENTER 226 North Kuakini Street Honolulu, Hawaii 96817 Ph: (808) 545-3933 Fax: (808) 545-2971 Correspondence Address: Alvin Cecil Regional Vice President Fresenius Medical Care – Hawaii Region Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Alvin Cecil Regional Manager Provider No. 122501	OAHU
5	FRESENIUS MEDICAL CARE – KAPAHULU 750 Palani Avenue Honolulu, Hawaii 96816 Ph: (808) 732-7702 Fax: (808) 732-7782 Correspondence Address: Alvin Cecil Regional Vice President Fresenius Medical Care – Hawaii Region Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Alvin Cecil Regional Manager Provider No. 122521
6	FRESENIUS MEDICAL CARE – LANAI COMMUNITY DIALYSIS CENTER 628 7^th Street Lanai City, Hawaii 96763 Mailing Address: P.O. Box 797 Lanai City, Hawaii 96763 Ph: (808) 565-9650 Fax: (808) 565-6357 Correspondence Address: Alvin Cecil Regional Vice President Fresenius Medical Care – Hawaii Region Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Alvin Cecil Regional Manager Provider No. 122506	LANAI
7	FRESENIUS MEDICAL CARE – WAHIAWA DIALYSIS CENTER 850 Kilani Avenue Wahiawa, Hawaii 96786 Mailing Address: 226 North Kuakini Street Honolulu, Hawaii 96817 Ph: (808) 621-5151 Fax: (808) 621-3884 Correspondence Address: Alvin Cecil Regional Vice President Fresenius Medical Care – Hawaii Region Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Alvin Cecil Regional Manager Provider No. 122500	OAHU
8	FRESENIUS MEDICAL CARE – WINDWARD DIALYSIS CENTER 45-480 Kaneohe Bay Drive Kaneohe, Hawaii 96744 Mailing Address: 226 North Kuakini Street Honolulu, Hawaii 96817 Ph: (808) 235-0885 Fax: (808) 235-1955 Correspondence Address: Alvin Cecil Regional Vice President Fresenius Medical Care – Hawaii Region Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Alvin Cecil Regional Manager Provider No. 122502	OAHU
9	KAIMUKI DIALYSIS FACILITY 3625 Harding Avenue Honolulu, Hawaii 96816-3701 Ph: (808) 735-2585 Fax: (808) 734-2583 Cheryl Solomon Director of Operations Provider No. 122520	OAHU
10	LIBERTY DIALYSIS - HAWAII LLC - HILO DIALYSIS FACILITY 140 Rainbow Drive Hilo, Hawaii 96720 Ph: (808) 935-3422 Fax: (808) 934-7901 Mailing Address: Denise Van Valkenburgh, V.P. – Clinical Operations 2226 Liliha Street, Suite 226 Honolulu, Hawaii 96817 Ph. (808) 547-6264 Fax: (808) 585-4601 Roberta Lovely Program Director Provider No. 122507	HAWAII
11	LIBERTY DIALYSIS - HAWAII LLC - KAHANA DIALYSIS FACILITY 10 Hoohui Street, Suite 100 Lahaina, Hawaii 96761 Ph: (808) 669-6628 Fax: (808) 669-1272 Mailing Address: Denise Van Valkenburgh, V.P. – Clinical Operations 2226 Liliha Street, Suite 226 Honolulu, Hawaii 96817 Ph. (808) 547-6264 Fax: (808) 585-4601 Roberta Lovely Program Director Provider No. 122515	MAUI
12	LIBERTY DIALYSIS - HAWAII LLC - KAUAI DIALYSIS FACILITY 3224 Elua Street Lihue, Hawaii 96766 Ph: (808) 245-3770 Fax: (808) 245-2390 Mailing Address: Denise Van Valkenburgh, V.P. – Clinical Operations 2226 Liliha Street, Suite 226 Honolulu, Hawaii 96817 Ph. (808) 547-6264 Fax: (808) 585-4601 Roberta Lovely Program Director Provider No. 122511	KAUAI
13	LIBERTY DIALYSIS - HAWAII LLC - KONA DIALYSIS FACILITY 79-1020 Haukapila Street, Suite 213 Kealakekua, Hawaii 96750 Ph: (808) 322-2131 Fax: (808) 322-0605 Mailing Address: Denise Van Valkenburgh, V.P. – Clinical Operations 2226 Liliha Street, Suite 226 Honolulu, Hawaii 96817 Ph. (808) 547-6264 Fax: (808) 585-4601 Roberta Lovely Program Director Provider No. 122513	HAWAII
14	LIBERTY DIALYSIS - HAWAII LLC - LEEWARD DIALYSIS FACILITY 91-2137 Fort Weaver Road Ewa Beach, Hawaii 96706 Ph: (808) 671-3042 Fax: (808) 677-7903 Mailing Address: Denise Van Valkenburgh, V.P. – Clinical Operations 2226 Liliha Street, Suite 226 Honolulu, Hawaii 96817 Ph. (808) 547-6264 Fax: (808) 585-4601 Roberta Lovely Program Director Provider No. 122512	OAHU
15	LIBERTY DIALYSIS - HAWAII LLC - MOLOKAI DIALYSIS FACILITY 28 Kamoi Street, Suite 400 Kaunakakai, Hawaii 96748 Ph: (808) 553-8088 Fax: (808) 553-3210 Mailing Address: Denise Van Valkenburgh, V.P. – Clinical Operations 2226 Liliha Street, Suite 226 Honolulu, Hawaii 96817 Ph. (808) 547-6264 Fax: (808) 585-4601 Roberta Lovely Program Director Provider No. 122517	MOLOKAI
16	LIBERTY DIALYSIS - HAWAII LLC - SIEMSEN DIALYSIS FACILITY 2230 Liliha Street Honolulu, Hawaii 96817 Ph: (808) 585-4612 Fax: (808) 538-7581 Mailing Address: Denise Van Valkenburgh, V.P. – Clinical Operations 2226 Liliha Street, Suite 226 Honolulu, Hawaii 96817 Ph. (808) 547-6264 Fax: (808) 585-4601 Roberta Lovely Program Director Provider No. 122518	OAHU
17	LIBERTY DIALYSIS - HAWAII LLC - WAIANAE DIALYSIS FACILITY 86-080 Farrington Highway Waianae, Hawaii 96792 Ph: (808) 696-0216 Fax: (808) 696-0345 Mailing Address: Denise Van Valkenburgh, V.P. – Clinical Operations 2226 Liliha Street, Suite 226 Honolulu, Hawaii 96817 Ph. (808) 547-6264 Fax: (808) 585-4601 Roberta Lovely Program Director Provider No. 122514	OAHU
18	LIBERTY DIALYSIS - HAWAII LLC - WEST KAUAI DIALYSIS FACILITY 4643 A Waimea Canyon Drive Waimea, Hawaii 96796 Ph: (808) 338-1100 Fax: (808) 338-1185 Mailing Address: Denise Van Valkenburgh, V.P. – Clinical Operations 2226 Liliha Street, Suite 226 Honolulu, Hawaii 96817 Ph. (808) 546-6264 Fax: (808) 585-4601 Roberta Lovely Program Director Provider No. 122516	KAUAI
19	LIBERTY DIALYSIS - NORTH HAWAII LLC 67-1123 Mamalahoa Highway, Suite 112 Kamuela, Hawaii 96743 Ph: (808) 930-2001 Fax: (808) 885-1506 Mailing Address: Jane Gibbons Executive Vice President 2226 Liliha Street, Suite 226 Honolulu, Hawaii 96817 Provider No. 122519	HAWAII
20	MAUI DIALYSIS FACILITY 105 Maui Lani Parkway, Suite 105 Wailuku, Hawaii 96793-2528 Ph: (808) 244-9600 Fax: (808) 244-5712 Mailing Address: Denise Van Valkenburgh, V.P. – Clinical Operations 2226 Liliha Street, Suite 226 Honolulu, Hawaii 96817 Ph. (808) 547-6264 Fax: (808) 585-4601 Roberta Lovely Program Director Provider No. 122510	MAUI

END STAGE RENAL DISEASE (ESRD) PROGRAM

PACIFIC AREA (AMERICAN SAMOA, GUAM, SAIPAN):

NUMBER	FACILITY	LOCATION
1	AMERICAN DIALYSIS CENTER, INC 1406 North Marine Corps Drive Tamuning, GU 96913 Ph: (671) 646-3773 Fax: (671) 647-2026 Eric Hayes Aministrator Provider No.: 652502	GUAM
2	COMMONWEALTH HEALTH CENTER P.O. Box 500409 CK (Navy Hill Road) Saipan, M.P. 96950 Ph: (670) 236-8246 Fax: (670) 234-8931 Joaquin I. Taitano Acting Deputy Secretary for Hospital Administration Provider No. 662500	SAIPAN
3	GUAM DIALYSIS CENTER, INC. – TAMUNING 633 Governor Carlos G. Camacho Road Tamuning, Guam 96911-3127 Ph: (671) 475-3600 Fax: (671) 477-3547 Charlyn Sangueza Administrator/CEO Provider No. 652500	GUAM
4	GUAM MEMORIAL HOSPITAL AUTHORITY 850 Governor Carlos Camacho Road Oka, Tamuning, Guam 96911 Ph: (671) 647-2444 Fax: (671) 649-0145 William I. McMillan, MBA, CHE Acting Administrator/CEO Provider No. 652300	GUAM
5	GUAM RENAL CENTER 265 Chalan Santo Papa Juan Pablo Dos Hagata, Guam 96910 Ph: (671) 475-3600 Fax: (671) 477-2759 Charlyn Sangueza Administrator/CEO Provider No. 652501	GUAM
6	LBJ TROPICAL MEDICAL CENTER Fagaalu Pago Pago, American Samoa 96799 Mailing Address: P.O. Box LBJ Pago Pago, American Samoa 96799 Ph: (684) 633-4590 Fax: (684) 633-1869 Taufete’e John Faumuina, LBJ CEO Chief Executive Officer Provider No. 642300	AMERICAN SAMOA
7	RENAL CENTERS OF GUAM, LLC 600 Harmon Loop Road, Suite 104 Dededo, GU 96929 Ph: (671) 637-3068 Fax: (671) 637-3073 Charlyn G. Haun Administrator Provider No.: 652503	GUAM
8	ST. JUDE RENAL CARE FACILITY Chalan Kiya Garapan, MP 96950 Mailing Address: P. O. Box 502878 Saipan, MP 96950 Ph: (670) 234-2901 Fax: (670) 234-2906 Vicente S. Aldan President Provider No. 66-2501	SAIPAN

OHCA/MEDICARE August 13, 2008 lk