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General NPI Number Information
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NPI Number | 1831433069
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Entity Type | Organization
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Legal Business Name | EASTER SEALS HAWAII
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Dates
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Enumeration Date | 11/09/2012
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 100 KAHELU AVE STE 230
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City | MILILANI
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State | HI
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Zip | 96789-3962
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Country | US
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Telephone | 808-536-1015
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Fax |
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Provider Business Mailing Address
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Address Line | 710 GREEN ST
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City | HONOLULU
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State | HI
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Zip | 96813-2119
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Country | US
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Telephone | 808-356-9900
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ANDREA PETTIFORD
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Credential |
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Telephone | 808-536-1015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | LSW 2013
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License Number State | HI
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