Organization
PREFERRED HOME & COMMUNITY BASED SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA A.F. ETRATA (PRESIDENT/CEO)
(808) 456-0078
Entity
Organization
Contact information
Practice address
94-412 MAIKOIKO STREET, WAIPAHU, HI 96797
(808) 456-0078
Mailing address
94-412 MAIKOIKO STREET, WAIPAHU, HI 96797-0000
(808) 456-0078
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
251S00000NX
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
540246
STATE OF HAWAII DEVELOPMENTA DISABILITIES MEDICAID WAIVER PROGRAM
HI
Enumeration date
12/20/2011
Last updated
04/14/2021
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