Healthcare Provider Details

I. General information

NPI: 1104903699
Provider Name (Legal Business Name): CASE MANAGEMENT PROFESSIONALS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1001 KAIMALIE ST #201
EWA BEACH HI
96706-6247
US

IV. Provider business mailing address

91-1001 KAIMALIE ST #201
EWA BEACH HI
96706-6247
US

V. Phone/Fax

Practice location:
  • Phone: 808-689-1937
  • Fax: 808-689-1933
Mailing address:
  • Phone: 808-689-1937
  • Fax: 808-689-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberHCBS 02-3
License Number StateHI

VIII. Authorized Official

Name: AGNES D REYES
Title or Position: PRESIDENT
Credential: R.N
Phone: 808-689-1937