MEDICARE: THE ARC IN HAWAII

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	IMR 27	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225168503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ARC IN HAWAII

Provider Business Mailing Address
First Line	:	3989 DIAMOND HEAD RD
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-4413
Country	:	US
Telephone Number	:	808-737-7995
Fax Number	:	808-732-9531

Provider Business Practice Location Address
First Line	:	3705 MAHINA AVE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-3724
Country	:	US
Telephone Number	:	808-737-7995
Fax Number	:	808-732-9531

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	COLLEEN KOJIMA
Credential	:
Telephone Number	:	808-737-7995

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/22/2020

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Directions to “THE ARC IN HAWAII ” Practice Location

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