1902883267 NPI number — FAMILY ADVOCACY PROGRAM, SCHOFIELD BARRACKS

Table of content: (NPI 1902883267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902883267 NPI number — FAMILY ADVOCACY PROGRAM, SCHOFIELD BARRACKS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY ADVOCACY PROGRAM, SCHOFIELD BARRACKS
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:
1902883267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91-109 NOHOIHOEWA WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EWA BEACH
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96706-4034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-683-1165
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 JARRETT WHITE RD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF SOCIAL WORK
Provider Business Practice Location Address City Name:
TAMC
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96859-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-6606
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
BEN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CHIEF, DEPARTMENT OF SOCIAL WORK
Authorized Official Telephone Number:
808-433-6606

Provider Taxonomy Codes

  • Taxonomy code: 286500000X , with the licence number:  1621 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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