1306046602 NPI number — CARERESOURCE HAWAII

Table of content: (NPI 1306046602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306046602 NPI number — CARERESOURCE HAWAII

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARERESOURCE HAWAII
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:
1306046602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
680 IWILEI RD
Provider Second Line Business Mailing Address:
SUITE 660
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96817-5388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-599-4999
Provider Business Mailing Address Fax Number:
808-531-2832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 IWILEI RD
Provider Second Line Business Practice Location Address:
SUITE 660
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96817-5388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-534-4224
Provider Business Practice Location Address Fax Number:
808-531-2832
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WAKASUGI
Authorized Official First Name:
THAD
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
808-599-9999

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA-16 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 533390-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 533390-05 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 533390-03 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 533390-04 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 533390-02 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com