Healthcare Provider Details

I. General information

NPI: 1952670358
Provider Name (Legal Business Name): PARENT CHILD DEVELOPMENT CENTER WAHIAWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 CALIFORNIA AVE
WAHIAWA HI
96786-2583
US

IV. Provider business mailing address

1403 CALIFORNIA AVE
WAHIAWA HI
96786-2583
US

V. Phone/Fax

Practice location:
  • Phone: 808-621-2322
  • Fax: 808-621-5033
Mailing address:
  • Phone: 808-621-2322
  • Fax: 808-621-5033

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: JOANNE HIGASHI
Title or Position: PROGRAM DIRECTOR
Credential: LCSW
Phone: 808-621-2322