Healthcare Provider Details

I. General information

NPI: 1831433069
Provider Name (Legal Business Name): EASTER SEALS HAWAII
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KAHELU AVE STE 230
MILILANI HI
96789-3962
US

IV. Provider business mailing address

710 GREEN ST
HONOLULU HI
96813-2119
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-1015
  • Fax:
Mailing address:
  • Phone: 808-356-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberLSW 2013
License Number StateHI

VIII. Authorized Official

Name: ANDREA PETTIFORD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 808-536-1015