Organization
MOHC-IKAIKA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLAIRE IVESON (IKAIKA PROGRAM MANAGER)
(808) 553-3276
Entity
Organization
Contact information
Practice address
30 OKI PLACE, KAUNAKAKAI, HI 96748
(808) 553-3276
(808) 553-4455
Mailing address
PO BOX 2099, KAUNAKAKAI, HI 96748-2099
(808) 553-3276
(808) 553-4455
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
646333
—
HI
Enumeration date
08/14/2012
Last updated
08/14/2012
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