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General NPI Number Information
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NPI Number | 1104640135
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Entity Type | Organization
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Legal Business Name | HAWAII INSTITUTE OF INNOVATION
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 65-1111A CHURCH RD
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City | WAIMEA
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State | HI
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Zip | 96743
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Country | US
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Telephone | 808-359-3326
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 959
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City | HONOKAA
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State | HI
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Zip | 96727-0959
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DODI PRITCHETT
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Credential | MED, BCBA, LBA
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Telephone | 808-359-3326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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