Healthcare Provider Details

I. General information

NPI: 1447311485
Provider Name (Legal Business Name): THE QUEENS COMMUNITY BASED PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 SOUTH BERETANIA STREET #308
HONOLULU HI
96813-4625
US

IV. Provider business mailing address

1301 PUNCHBOWL STREET
HONOLULU HI
96813-2499
US

V. Phone/Fax

Practice location:
  • Phone: 808-547-4628
  • Fax: 808-547-4625
Mailing address:
  • Phone: 808-547-4628
  • Fax: 808-547-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberHCBS0509
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. RIX MAURER III
Title or Position: VICE PRESIDENT FINANCE
Credential:
Phone: 808-547-4329