Provider Demographics
NPI:1366005951
Name:QUEEN'S DEVELOPMENT CORPORATION & SUBSIDIARIES
Entity Type:Organization
Organization Name:QUEEN'S DEVELOPMENT CORPORATION & SUBSIDIARIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-691-4600
Mailing Address - Street 1:1301 PUNCHBOWL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2402
Mailing Address - Country:US
Mailing Address - Phone:808-691-4600
Mailing Address - Fax:808-691-4559
Practice Address - Street 1:66-125 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1601
Practice Address - Country:US
Practice Address - Phone:808-691-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEEN'S DEVELOPMENT CORPORATION & SUBSIDIARIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service