Healthcare Provider Details

I. General information

NPI: 1538438544
Provider Name (Legal Business Name): PREFERRED HOME & COMMUNITY BASED SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-412 MAIKOIKO STREET
WAIPAHU HI
96797
US

IV. Provider business mailing address

94-412 MAIKOIKO STREET
WAIPAHU HI
96797-0000
US

V. Phone/Fax

Practice location:
  • Phone: 808-456-0078
  • Fax:
Mailing address:
  • Phone: 808-456-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number251S00000NX
License Number StateHI

VIII. Authorized Official

Name: MARIA A.F. ETRATA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 808-456-0078