Healthcare Provider Details

I. General information

NPI: 1306604194
Provider Name (Legal Business Name): ACCELERATED REAL ESTATE INVESTMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 QUEEN ST APT 7D
HONOLULU HI
96813-4657
US

IV. Provider business mailing address

244 5TH AVE STE 2774
NEW YORK NY
10001-7604
US

V. Phone/Fax

Practice location:
  • Phone: 877-678-1774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ILIJHA-ESRAEL BASTIEN
Title or Position: EXECUTIVE DIRECTOR/MENTAL HEALTH C.
Credential: LPC
Phone: 877-678-1774