Provider Demographics
NPI:1225372840
Name:HAWAII BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:HAWAII BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:PETRINA JOY
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-895-5603
Mailing Address - Street 1:200 KANOELEHUA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 KANOELEHUA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4648
Practice Address - Country:US
Practice Address - Phone:808-895-5603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI=========Medicaid