1255609202 NPI number — DEPT. OF HEALTH-HAWAII-CHILD AND ADOLESCENT MENTAL HEALTH DIVISION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255609202 NPI number — DEPT. OF HEALTH-HAWAII-CHILD AND ADOLESCENT MENTAL HEALTH DIVISION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPT. OF HEALTH-HAWAII-CHILD AND ADOLESCENT MENTAL HEALTH DIVISION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255609202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3627 KILAUEA AVE
Provider Second Line Business Mailing Address:
ROOM 101-ATTN: PHAO
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96816-2317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-733-4198
Provider Business Mailing Address Fax Number:
808-733-8375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 FRASER AVE
Provider Second Line Business Practice Location Address:
MAUI-FGC-LANAI
Provider Business Practice Location Address City Name:
LANAI CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-565-7915
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MICHELS
Authorized Official First Name:
M.
Authorized Official Middle Name:
STANTON
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
808-733-9339

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)