Provider Demographics
NPI:1437324050
Name:CASE MANAGEMENT PROFESSIONALS, INC
Entity Type:Organization
Organization Name:CASE MANAGEMENT PROFESSIONALS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-689-1937
Mailing Address - Street 1:91-616 ONELUA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2419
Mailing Address - Country:US
Mailing Address - Phone:808-689-1937
Mailing Address - Fax:808-689-1933
Practice Address - Street 1:91-616 ONELUA ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2419
Practice Address - Country:US
Practice Address - Phone:808-689-1937
Practice Address - Fax:808-689-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHCBS-08-002251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID506024-01Medicaid