1376884429 NPI number — S.T.A.R.R.(SOBRIETYTRAINING & RECOVERY RESOURCES) INC.

Table of content: SUSAN RENA GLASS NP (NPI 1639219546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376884429 NPI number — S.T.A.R.R.(SOBRIETYTRAINING & RECOVERY RESOURCES) INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S.T.A.R.R.(SOBRIETYTRAINING & RECOVERY RESOURCES) 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:
1376884429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 HEKILI ST
Provider Second Line Business Mailing Address:
#A1603
Provider Business Mailing Address City Name:
KAILUA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96734-2800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-263-1923
Provider Business Mailing Address Fax Number:
808-263-1920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 AULIKE ST
Provider Second Line Business Practice Location Address:
SUITE 217
Provider Business Practice Location Address City Name:
KAILUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96734-2758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-263-1923
Provider Business Practice Location Address Fax Number:
808-263-1920
Provider Enumeration Date:
03/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KAHALE
Authorized Official First Name:
DESRAE
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-722-2437

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  200 , 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)





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