1821367723 NPI number — LEEWARD EARLY CHILDHOOD SERVICES PROGRAM

Table of content: DR. AKUA AFRAH AMOAH MD, MPH (NPI 1104610245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821367723 NPI number — LEEWARD EARLY CHILDHOOD SERVICES PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEEWARD EARLY CHILDHOOD SERVICES PROGRAM
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:
1821367723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
860 FOURTH ST
Provider Second Line Business Mailing Address:
ROOM #150
Provider Business Mailing Address City Name:
PEARL CITY
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96782-3312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-453-6960
Provider Business Mailing Address Fax Number:
808-453-6964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
860 FOURTH ST
Provider Second Line Business Practice Location Address:
ROOM #150
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-3312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-453-6960
Provider Business Practice Location Address Fax Number:
808-453-6964
Provider Enumeration Date:
12/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BRACEROS
Authorized Official First Name:
MAE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PROGRAM MANAGER
Authorized Official Telephone Number:
808-453-6960

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64626802 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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