Healthcare Provider Details

I. General information

NPI: 1801165410
Provider Name (Legal Business Name): KAILUA EARLY INTERVENTION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 N KALAHEO AVE STE A203
KAILUA HI
96734-1869
US

IV. Provider business mailing address

970 N KALAHEO AVE STE A203
KAILUA HI
96734-1869
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-4999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateHI

VIII. Authorized Official

Name: MAJKEN MECHLING
Title or Position: CEO/PRESIDENT
Credential:
Phone: 808-536-1015