Provider Demographics
NPI:1629660725
Name:ROMAN CATHOLIC CHURCH IN THE STATE OF HAWAII
Entity Type:Organization
Organization Name:ROMAN CATHOLIC CHURCH IN THE STATE OF HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT/BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-875-8754
Mailing Address - Street 1:25 W LIPOA ST
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8128
Mailing Address - Country:US
Mailing Address - Phone:808-875-8754
Mailing Address - Fax:808-875-4674
Practice Address - Street 1:25 W LIPOA ST
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8128
Practice Address - Country:US
Practice Address - Phone:808-875-8754
Practice Address - Fax:808-875-4674
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROMAN CATHOLIC CHURCH IN THE STATE OF HAWAII
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI757883Medicaid