1376553107 NPI number — KU ALOHA OLA MAU

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 1376553107 NPI number — KU ALOHA OLA MAU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KU ALOHA OLA MAU
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:
DRUG ADDICTION SERVICES OF HAWAII INC
Provider Other Organization Name Type Code:
4
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:
1376553107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 N NIMITZ HWY
Provider Second Line Business Mailing Address:
C302
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-538-0704
Provider Business Mailing Address Fax Number:
808-538-0474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 N NIMITZ HWY
Provider Second Line Business Practice Location Address:
C302
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-538-0704
Provider Business Practice Location Address Fax Number:
808-538-0474
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
808-538-0704

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 509218-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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