1588971303 NPI number — THE GREEN WILL CONSERVANCY INC

Table of content: (NPI 1588971303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588971303 NPI number — THE GREEN WILL CONSERVANCY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GREEN WILL CONSERVANCY 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:
1588971303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1341
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAHOA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96778-1341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-965-5349
Provider Business Mailing Address Fax Number:
808-965-5036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14-803B SEAVIEW ROAD
Provider Second Line Business Practice Location Address:
NANAWALE ESTATES
Provider Business Practice Location Address City Name:
PAHOA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96778-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-965-5349
Provider Business Practice Location Address Fax Number:
808-965-5036
Provider Enumeration Date:
09/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CAPATCH
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
808-965-5349

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3265 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 3331 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00C0222764 . This is a "TRICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00C0222764 . This is a "HMSA BLUE CROSS BLUE SHIELD OF HAWAII" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00C0222764 . This is a "HMSA 65C PLUS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00C0222764 . This is a "HMSA PPO" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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