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General NPI Number Information
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NPI Number | 1821628280
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Entity Type | Organization
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Legal Business Name | RESIDENTIAL YOUTH SERVICES & EMPOWERMENT
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 42-470 KALANIANAOLE HWY
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City | KAILUA
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State | HI
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Zip | 96734-4373
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Country | US
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Telephone | 808-498-5180
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Fax |
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Provider Business Mailing Address
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Address Line | 42-470 KALANIANAOLE HWY
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City | KAILUA
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State | HI
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Zip | 96734-4373
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Country | US
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Telephone | 808-498-5180
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DEREK DICKARD
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Credential |
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Telephone | 808-260-0348
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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 |
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License Number State |
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