Healthcare Provider Details

I. General information

NPI: 1558147579
Provider Name (Legal Business Name): ANDERSON THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 ALA KULA ST
HILO HI
96720-3137
US

IV. Provider business mailing address

PO BOX 353
MOUNTAIN VIEW HI
96771-0353
US

V. Phone/Fax

Practice location:
  • Phone: 808-443-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ULA ANDERSON
Title or Position: PRESIDENT
Credential:
Phone: 808-443-7700