Provider Demographics
NPI:1093845521
Name:STATE OF HAWAII DEPARTMENT OF EDUCATION
Entity Type:Organization
Organization Name:STATE OF HAWAII DEPARTMENT OF EDUCATION
Other - Org Name:HAWAII DEPT OF EDUCATION
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, STUDENT SERVICES BRANCH
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-305-9787
Mailing Address - Street 1:475 22ND AVE RM 127
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-4400
Mailing Address - Country:US
Mailing Address - Phone:808-305-9749
Mailing Address - Fax:
Practice Address - Street 1:475 22ND AVE RM 127
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-4400
Practice Address - Country:US
Practice Address - Phone:808-305-9749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI581000Medicaid