Healthcare Provider Details

I. General information

NPI: 1366677742
Provider Name (Legal Business Name): COORDINATED SERVICES FOR THE ELDERLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 KINOOLE ST SUITE 106
HILO HI
96720-3872
US

IV. Provider business mailing address

1055 KINOOLE ST SUITE 106
HILO HI
96720-3872
US

V. Phone/Fax

Practice location:
  • Phone: 808-961-8777
  • Fax: 808-961-8704
Mailing address:
  • Phone: 808-961-8777
  • Fax: 808-961-8704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MRS. ZOEANNE M. BIANCHI
Title or Position: ACCOUNT CLERK
Credential:
Phone: 808-961-8777