Provider Demographics
NPI:1164884649
Name:ARC OF MAUI COUNTY
Entity Type:Organization
Organization Name:ARC OF MAUI COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-242-5781
Mailing Address - Street 1:450A KANALOA STREET
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732
Mailing Address - Country:US
Mailing Address - Phone:808-242-5781
Mailing Address - Fax:808-244-4061
Practice Address - Street 1:450A KANALOA STREET
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732
Practice Address - Country:US
Practice Address - Phone:808-242-5781
Practice Address - Fax:808-244-4061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARC OF MAUI COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIIMR-37320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0082499-2Medicaid