=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669184636
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED CASE MANAGEMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2022
-----------------------------------------------------
Last Update Date | 12/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1708 AUIKI ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96819-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-650-2466
-----------------------------------------------------
Fax | 808-600-3761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 700083
-----------------------------------------------------
City | KAPOLEI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96709-0083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-650-2466
-----------------------------------------------------
Fax | 808-600-3761
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AGA MARNETTE ACDAL ROXAS
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 808-650-2466
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------