1821406943 NPI number — GREYWOLF PSYCHIATRY SERVICES, INC

Table of content: (NPI 1821406943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821406943 NPI number — GREYWOLF PSYCHIATRY SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREYWOLF PSYCHIATRY 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:
1821406943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91-1019 KAMAAHA AVE
Provider Second Line Business Mailing Address:
1004
Provider Business Mailing Address City Name:
KAPOLEI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96707-2996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-380-4550
Provider Business Mailing Address Fax Number:
603-658-2679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91-1019 KAMAAHA AVE
Provider Second Line Business Practice Location Address:
1004
Provider Business Practice Location Address City Name:
KAPOLEI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96707-2996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-380-4500
Provider Business Practice Location Address Fax Number:
603-658-2679
Provider Enumeration Date:
08/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GREYWOLF
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
TAYLOR
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
603-380-4550

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  1454 , 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)





Copyright © 2007-2025 www.npivalidator.com