Healthcare Provider Details

I. General information

NPI: 1104661313
Provider Name (Legal Business Name): ACHIEVING STARS HI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FORT STREET MALL
HONOLULU HI
96813-3721
US

IV. Provider business mailing address

1133 SAGE ST
FAR ROCKAWAY NY
11691-4820
US

V. Phone/Fax

Practice location:
  • Phone: 833-666-3115
  • Fax:
Mailing address:
  • Phone: 609-455-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. MOSHE HIRSCHMAN
Title or Position: MEMBER
Credential:
Phone: 609-455-1123