Healthcare Provider Details

I. General information

NPI: 1568230993
Provider Name (Legal Business Name): COMMUNITY CARE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N VINEYARD BLVD STE A3255645
HONOLULU HI
96817-3950
US

IV. Provider business mailing address

200 N VINEYARD BLVD STE A3255645
HONOLULU HI
96817-3950
US

V. Phone/Fax

Practice location:
  • Phone: 808-501-0110
  • Fax: 808-204-2488
Mailing address:
  • Phone: 808-501-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE REED
Title or Position: OWNER/MANAGER/MEMBER
Credential: OTR/L
Phone: 808-501-0110