=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770219842
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE HAWAII, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2022
-----------------------------------------------------
Last Update Date | 03/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 197 SAND ISLAND ACCESS RD STE 202
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96819-4901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-533-3936
-----------------------------------------------------
Fax | 808-460-8867
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1345 S BERETANIA ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-533-3936
-----------------------------------------------------
Fax | 808-460-8860
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | GENEVIEVE AYIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-791-6183
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------