Provider Demographics
NPI:1003136433
Name:MAUI CENTER FOR CHILD DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:MAUI CENTER FOR CHILD DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:808-873-7700
Mailing Address - Street 1:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:PUUNENE
Mailing Address - State:HI
Mailing Address - Zip Code:96784-1379
Mailing Address - Country:US
Mailing Address - Phone:808-873-7700
Mailing Address - Fax:808-873-7710
Practice Address - Street 1:244 PAPA PL
Practice Address - Street 2:SUITE 102
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2988
Practice Address - Country:US
Practice Address - Phone:808-873-7700
Practice Address - Fax:808-873-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 2251P0200X
HI222225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty