Provider Demographics
NPI:1164626479
Name:QUEEN'S DEVELOPMENT CORPORATION & SUBSIDIARIES
Entity Type:Organization
Organization Name:QUEEN'S DEVELOPMENT CORPORATION & SUBSIDIARIES
Other - Org Name:QUEEN'S HEALTHCARE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-535-8737
Mailing Address - Street 1:1099 ALAKEA ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4511
Mailing Address - Country:US
Mailing Address - Phone:808-535-8737
Mailing Address - Fax:808-535-8710
Practice Address - Street 1:377 KEAHOLE ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3405
Practice Address - Country:US
Practice Address - Phone:808-396-6675
Practice Address - Fax:808-395-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH103153Medicare PIN