1578615514 NPI number — BIG ISLAND SUBSTANCE ABUSE COUNCIL

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578615514 NPI number — BIG ISLAND SUBSTANCE ABUSE COUNCIL

Employer Identification Number (EIN):

Provider Organization Name:

BIG ISLAND SUBSTANCE ABUSE COUNCIL

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

Provider Other Organization Name Type Code:

6

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:

1578615514

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

07/29/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

16-179 MELEKAHIWA STREET

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

KEA'AU

Provider Business Mailing Address State Name:

HI

Provider Business Mailing Address Postal Code:

96749

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

808-969-9994

Provider Business Mailing Address Fax Number:

808-969-7570

Provider First Line Business Practice Location Address:

297 WAIANUENUE AVENUE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

HILO

Provider Business Practice Location Address State Name:

HI

Provider Business Practice Location Address Postal Code:

96720-2438

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

808-935-4927

Provider Business Practice Location Address Fax Number:

808-934-8067

Provider Enumeration Date:

01/18/2007

Authorized Official Last Name:

PRESTON-PITA

Authorized Official First Name:

HANNAH

Authorized Official Middle Name:

K

Authorized Official Title or Position:

CEO

Authorized Official Telephone Number:

808-969-9994

• Taxonomy code: 261QM0850X , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QM0855X , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QR0405X , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 251S00000X , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: J000920-7 . This is a "HILO COMMERCIAL #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: L000920-3 . This is a "E. HI-ADOL. COMMERCIAL #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: B000920-5 . This is a "KONA COMMERCIAL PROV. #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: 00J000920-7 . This is a "HILO QUEST PROVIDER #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: 3747 . This is a "ALOHACARE PROVIDER #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: 00P000920-4 . This is a "WAIMEA QUEST PROVIDER #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: P000920-4 . This is a "WAIMEA COMMERCIAL PROV. #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: 00B000920-5 . This is a "KONA QUEST PROVIDER #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: E000920-8 . This is a "W. HI-ADOL COMMECIAL #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: 00E000920-8 . This is a "W. HI-ADOL QUEST PROV #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: 00L000920-3 . This is a "E. HI-ADOL. QUEST #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: F0009206 . This is a "KAPOLEI QUEST PROVIDER #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: G0009204 . This is a "WAIANAE QUEST PROVIDER #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".