Healthcare Provider Details

I. General information

NPI: 1073569521
Provider Name (Legal Business Name): OFFICE FOR SOCIAL MINISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HOLOMUA ST
HILO HI
96720-5132
US

IV. Provider business mailing address

140 HOLOMUA ST
HILO HI
96720-5132
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-3050
  • Fax: 808-969-4874
Mailing address:
  • Phone: 808-935-3050
  • Fax: 808-969-4874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number08661301
License Number StateHI

VIII. Authorized Official

Name: MS. SUSAN KAYE LUNDBURG
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 808-935-3050