Healthcare Provider Details

I. General information

NPI: 1366879298
Provider Name (Legal Business Name): CENTRAL UNION CHURCH OF HONOLULU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S BERETANIA ST
HONOLULU HI
96826-1104
US

IV. Provider business mailing address

1660 S BERETANIA ST
HONOLULU HI
96826-1104
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-5910
  • Fax: 808-983-3827
Mailing address:
  • Phone: 808-941-0957
  • Fax: 808-440-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADHC-4
License Number StateHI

VIII. Authorized Official

Name: MRS. TASHA L. SAWAI
Title or Position: COMPTROLLER
Credential: CPA, CGMA
Phone: 808-440-3017