Healthcare Provider Details

I. General information

NPI: 1093859431
Provider Name (Legal Business Name): PHOENIX ONE ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1953 S BERETANIA ST SUITE 3-B
HONOLULU HI
96826-1300
US

IV. Provider business mailing address

PO BOX 11389
HONOLULU HI
96828-0389
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-7366
  • Fax: 808-942-1938
Mailing address:
  • Phone: 808-955-7366
  • Fax: 808-942-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number51, 169, 124, 70, 73
License Number StateHI

VIII. Authorized Official

Name: MR. GLENN W. BAER
Title or Position: PRESIDENT
Credential:
Phone: 808-955-7366