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General NPI Number Information
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NPI Number | 1063982627
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Entity Type | Organization
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Legal Business Name | EVERGREEN ADC HAWAII
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Dates
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Enumeration Date | 11/27/2018
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 1124 FORT STREET MALL FL 2
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City | HONOLULU
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State | HI
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Zip | 96813-2715
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Country | US
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Telephone | 808-372-8257
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Fax | 808-946-7571
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Provider Business Mailing Address
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Address Line | 1124 FORT STREET MALL FL 2
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City | HONOLULU
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State | HI
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Zip | 96813-2715
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Country | US
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Telephone | 808-372-8257
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL PARK
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Credential |
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Telephone | 808-372-8257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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