=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861014565
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CASE MANAGEMENT SOLUTIONS, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2020
-----------------------------------------------------
Last Update Date | 05/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 94-216 FARRINGTON HWY STE B2-302
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-1922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-377-6100
-----------------------------------------------------
Fax | 808-377-6101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 94-216 FARRINGTON HWY # 337
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-1922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-377-6100
-----------------------------------------------------
Fax | 808-377-6101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/ OWNER
-----------------------------------------------------
Name | JOY ANNE MENDOZA
-----------------------------------------------------
Credential | RN BSN
-----------------------------------------------------
Telephone | 808-377-6100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------