Provider Demographics
NPI:1063481794
Name:HAWAII PROFESSIONALS HOMECARE SERVICES INC.
Entity Type:Organization
Organization Name:HAWAII PROFESSIONALS HOMECARE SERVICES INC.
Other - Org Name:HAWAII PROFESSIONAL HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUTOZ-DEHARNE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-245-7211
Mailing Address - Street 1:377 KEAHOLE STREET SUITE E106
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-3412
Mailing Address - Country:US
Mailing Address - Phone:808-396-2160
Mailing Address - Fax:808-396-2161
Practice Address - Street 1:377 KEAHOLE STREET SUITE E106
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3412
Practice Address - Country:US
Practice Address - Phone:808-396-2160
Practice Address - Fax:808-396-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHHA35251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00226100OtherHMSA PIN
HI52316901Medicaid
HI52316901Medicaid