State of Hawaii Department of Health

Office of Health Care Assurance

Medicare Section

END STAGE RENAL DISEASE (ESRD) PROGRAM

HAWAII:

NUMBER	FACILITY	LOCATION
1	DSI – ALOHA DIALYSIS 1520 Liliha Street Honolulu, Hawaii 96817 Ph: (808) 531-1748 Fax: (808) 531-1501 Correspondence Address: Debbie Taylor Sr. Vice President for Operations DSI – Aloha Dialysis Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Provider No. 122503	OAHU
2	DSI – KAPOLEI DIALYSIS 555 Farrington Highway Kapolei, Hawaii 96707 Ph: (808) 693-8980 Fax: (808) 693-8968 Correspondence Address: Debbie Taylor Sr. Vice President for Operations DSI – Kapolei Dialysis Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Provider No. 122508	OAHU
3	DSI – PEARLRIDGE DIALYSIS 98-1005 Moanalua Road, Suite 420 Aiea, Hawaii 96701 Ph: (808) 440-4800 Fax: (808) 440-4827 Correspondence Address: Debbie Taylor Sr. Vice President for Operations DSI – Pearlridge Dialysis Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Provider No. 122509	OAHU
4	DSI – HONOLULU DIALYSIS 226 North Kuakini Street Honolulu, Hawaii 96817 Ph: (808) 545-3933 Fax: (808) 545-2971 Correspondence Address: Debbie Taylor Sr. Vice President for Operations DSI – Honolulu Dialysis Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Provider No. 122501	OAHU
5	DSI – KAPAHULU DIALYSIS 750 Palani Avenue Honolulu, Hawaii 96816 Ph: (808) 732-7702 Fax: (808) 732-7782 Correspondence Address: Debbie Taylor Sr. Vice President for Operations DSI – Kapahulu Dialysis Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Provider No. 122521	OAHU
6	DSI – KO’OLAU DIALYSIS 47-388 Hui Iwa Street Kaneohe, Hawaii 96744 Ph: (808) 239-3400 Fax: (808) 239-3401 Correspondence Address: Debbie Taylor Sr. Vice President for Operations DSI – Ko’olau Dialysis Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Provider No. 122523	OAHU
7	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: Fresenius Medical Care – Hawaii Region Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Provider No. 122506	LANAI
8	FRESENIUS MEDICAL CARE – WAHIAWA DIALYSIS 850 Kilani Avenue Wahiawa, Hawaii 96786 Ph: (808) 621-5151 Fax: (808) 621-3884 Correspondence Address: Debbie Taylor Sr. Vice President for Operations DSI – Wahiawa Dialysis Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Provider No. 122500	OAHU
9	DSI – WINDWARD DIALYSIS 45-480 Kaneohe Bay Drive Kaneohe, Hawaii 96744 Ph: (808) 235-0885 Fax: (808) 235-1955 Correspondence Address: Debbie Taylor Sr. Vice President for Operations DSI – Windward Dialysis Kapolei Building, Suite 245 1001 Kamokila Boulevard Kapolei, Hawaii 96707 Provider No. 122502	OAHU
10	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
11	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
12	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
13	LIBERTY DIALYSIS – HAWAII – KAILUA DIALYSIS FACILITY 25 Kaneohe Bay Drive, Suite 230 Kailua, Hawaii 96734-1711 Ph: (808)236-5001 Fax: (808)236-5002 Mailing Address: Denise Van Valkenburgh, V.P. – Clinical Operations 2226 Liliha Street, Suite 226 Honolulu, Hawaii 96817 (206)547-6264 Fax: (206)585-4601 Roberta Lovely Program Directory Provider No. 122524	OAHU
14	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
15	LIBERTY DIALYSIS - HAWAII LLC - KONA DIALYSIS FACILITY 78-6831 Alii Drive, Suite 336 Kailua Kona, Hawaii 96740 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
16	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
17	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
18	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
19	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
20	LIBERTY DIALYSIS - HAWAII LLC – WAIPAHU DIALYSIS FACILITY 94-450 Mokuola Street, Suite 109 Waipahu, Hawaii 96797 Ph: (808) 697-2200 Fax: (808) 678-3961 Mailing Address: Jane Gibbons Executive Vice President 2226 Liliha Street, Suite 226 Honolulu, Hawaii 96817 Provider No. 122522
21	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
22	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
23	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

OHCA/MEDICARE May 13, 2013 kh