Provider Demographics
NPI:1558630418
Name:PARENT CHILD DEVELOPMENT CENTER WAIPAHU
Entity Type:Organization
Organization Name:PARENT CHILD DEVELOPMENT CENTER WAIPAHU
Other - Org Name:WAIANAE COAST EARLY CHILDHOOD SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:IMANAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:808-676-5584
Mailing Address - Street 1:94-408 AKOKI ST
Mailing Address - Street 2:202
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2733
Mailing Address - Country:US
Mailing Address - Phone:808-676-5584
Mailing Address - Fax:808-676-5587
Practice Address - Street 1:94-408 AKOKI ST
Practice Address - Street 2:202
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2733
Practice Address - Country:US
Practice Address - Phone:808-676-5584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI522252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI646440001Medicaid