1538438544 NPI number — PREFERRED HOME & COMMUNITY BASED SERVICES, INC.

Table of content: DR. SARAH MARIE DESNYDER M.D. (NPI 1912150665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538438544 NPI number — PREFERRED HOME & COMMUNITY BASED SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED HOME & COMMUNITY BASED SERVICES, INC.
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:
1538438544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94-412 MAIKOIKO STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAIPAHU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96797-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-456-0078
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94-412 MAIKOIKO STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-456-0078
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ETRATA
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
A.F.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
808-456-0078

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  251S00000NX , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 540246 . This is a "STATE OF HAWAII DEVELOPMENTA DISABILITIES MEDICAID WAIVER PROGRAM" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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