Healthcare Provider Details

I. General information

NPI: 1558630418
Provider Name (Legal Business Name): PARENT CHILD DEVELOPMENT CENTER WAIPAHU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-408 AKOKI ST 202
WAIPAHU HI
96797-2733
US

IV. Provider business mailing address

94-408 AKOKI ST 202
WAIPAHU HI
96797-2733
US

V. Phone/Fax

Practice location:
  • Phone: 808-676-5584
  • Fax:
Mailing address:
  • Phone: 808-676-5584
  • Fax: 808-676-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number522
License Number StateHI

VIII. Authorized Official

Name: SHARON IMANAKA
Title or Position: PROGRAM DIRECTOR
Credential: M.S., CCC-SLP
Phone: 808-676-5584