1184992158 NPI number — DEPT. OF HEALTH-HAWAII-CHILD AND ADOLESCENT MENTAL HEALTH DIVISION

Table of content: (NPI 1184992158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184992158 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:
1184992158
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:
65 MAKAENA ST
Provider Second Line Business Practice Location Address:
MAUI-FGC-MOLOKAI
Provider Business Practice Location Address City Name:
KAUNAKAKAI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-553-5067
Provider Business Practice Location Address Fax Number:
808-553-9859
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)





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