Healthcare Provider Details

I. General information

NPI: 1063565372
Provider Name (Legal Business Name): CNA SENIOR TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 SIERRA DR
HONOLULU HI
96816-3213
US

IV. Provider business mailing address

2506 IPULEI WAY
HONOLULU HI
96816-3510
US

V. Phone/Fax

Practice location:
  • Phone: 808-735-9500
  • Fax: 808-735-0800
Mailing address:
  • Phone: 808-735-9500
  • Fax: 808-735-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberPUC1753-C
License Number StateHI

VIII. Authorized Official

Name: MRS. JENNIFER W WONG
Title or Position: OWNER
Credential: CNA
Phone: 808-358-7100