Provider Demographics
NPI:1073569521
Name:OFFICE FOR SOCIAL MINISTRY
Entity Type:Organization
Organization Name:OFFICE FOR SOCIAL MINISTRY
Other - Org Name:MOBILE CARE HEALTH PROJECT
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:LUNDBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-935-3050
Mailing Address - Street 1:140 HOLOMUA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5132
Mailing Address - Country:US
Mailing Address - Phone:808-935-3050
Mailing Address - Fax:808-969-4874
Practice Address - Street 1:140 HOLOMUA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5132
Practice Address - Country:US
Practice Address - Phone:808-935-3050
Practice Address - Fax:808-969-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI08661301261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08661301Medicaid