Provider Demographics
NPI:1043447089
Name:YAP, GRACEMARIE RAGO
Entity Type:Individual
Prefix:MRS
First Name:GRACEMARIE
Middle Name:RAGO
Last Name:YAP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 BECKLEY ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3466
Mailing Address - Country:US
Mailing Address - Phone:808-722-5305
Mailing Address - Fax:
Practice Address - Street 1:1807 BECKLEY ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3466
Practice Address - Country:US
Practice Address - Phone:808-722-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHCBS09-1099311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home