Healthcare Provider Details

I. General information

NPI: 1659586725
Provider Name (Legal Business Name): LDS FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S BERETANIA ST SUITE 402
HONOLULU HI
96826-1932
US

IV. Provider business mailing address

1500 S BERETANIA ST SUITE 402
HONOLULU HI
96826-1932
US

V. Phone/Fax

Practice location:
  • Phone: 808-945-3690
  • Fax: 808-945-2811
Mailing address:
  • Phone: 808-945-3690
  • Fax: 808-945-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number870489254
License Number StateHI

VIII. Authorized Official

Name: MR. ALIFELETI MALUPO
Title or Position: AGENCY DIRECTOR
Credential: MED
Phone: 808-945-3690