Provider Demographics
NPI:1518157379
Name:ARC OF MAUI COUNTY
Entity Type:Organization
Organization Name:ARC OF MAUI COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGUNDO
Authorized Official - Suffix:IV
Authorized Official - Credentials:ACCOUNTANT
Authorized Official - Phone:808-242-5781
Mailing Address - Street 1:95 MAHALANI ST
Mailing Address - Street 2:SUITE 17
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2521
Mailing Address - Country:US
Mailing Address - Phone:808-242-5781
Mailing Address - Fax:808-244-4061
Practice Address - Street 1:179 HALE KAI ST
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7002
Practice Address - Country:US
Practice Address - Phone:808-242-5781
Practice Address - Fax:808-244-4061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIIMR-36320600000X
HIIMR-37320600000X
HIIMR-38320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI519275Medicaid
HI082499Medicaid
HI085282Medicaid