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General NPI Number Information
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NPI Number | 1538438544
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Entity Type | Organization
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Legal Business Name | PREFERRED HOME & COMMUNITY BASED SERVICES, INC.
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 94-412 MAIKOIKO STREET
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City | WAIPAHU
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State | HI
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Zip | 96797
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Country | US
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Telephone | 808-456-0078
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Fax |
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Provider Business Mailing Address
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Address Line | 94-412 MAIKOIKO STREET
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City | WAIPAHU
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State | HI
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Zip | 96797-0000
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Country | US
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Telephone | 808-456-0078
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MARIA A.F. ETRATA
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Credential |
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Telephone | 808-456-0078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 251S00000NX
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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