Healthcare Provider Details

I. General information

NPI: 1285996900
Provider Name (Legal Business Name): ALOHA PSYCHIATRIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ELM ST 10TH FLOOR
MANCHESTER NH
03101-2007
US

IV. Provider business mailing address

PO BOX 1585
LACONIA NH
03247-1585
US

V. Phone/Fax

Practice location:
  • Phone: 808-772-9212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14964
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14992
License Number StateNH

VIII. Authorized Official

Name: DR. DOREEN FUKUSHIMA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-295-1651