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General NPI Number Information
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NPI Number | 1447311485
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Entity Type | Organization
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Legal Business Name | THE QUEENS COMMUNITY BASED PROGRAMS
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 838 SOUTH BERETANIA STREET #308
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City | HONOLULU
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State | HI
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Zip | 96813-4625
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Country | US
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Telephone | 808-547-4628
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Fax | 808-547-4625
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Provider Business Mailing Address
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Address Line | 1301 PUNCHBOWL STREET
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City | HONOLULU
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State | HI
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Zip | 96813-2499
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Country | US
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Telephone | 808-547-4628
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Fax | 808-547-4625
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Authorized Official
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Title or Position | VICE PRESIDENT FINANCE
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Name | MR. RIX MAURER III
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Credential |
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Telephone | 808-547-4329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | HCBS0509
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License Number State | HI
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