Provider Demographics
NPI:1205838539
Name:MAUI YOUTH AND FAMILY SERVICES INC
Entity Type:Organization
Organization Name:MAUI YOUTH AND FAMILY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:GNAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:QCSW
Authorized Official - Phone:808-579-8414
Mailing Address - Street 1:PO BOX 790006
Mailing Address - Street 2:
Mailing Address - City:PAIA
Mailing Address - State:HI
Mailing Address - Zip Code:96779-0006
Mailing Address - Country:US
Mailing Address - Phone:808-579-8414
Mailing Address - Fax:808-579-8426
Practice Address - Street 1:200 IKE DR
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9718
Practice Address - Country:US
Practice Address - Phone:808-579-8414
Practice Address - Fax:808-579-8426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X
HI12TLP322D00000X
HI74STF322D00000X
HI51STF3245S0500X
HI60STF3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251V00000XAgenciesVoluntary or Charitable
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Not Answered3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000245324OtherHMSA BLUE CROSS BLUE SHIE