Provider Demographics
NPI:1679768352
Name:QUEEN'S DEVELOPMENT CORPORATION & SUBSIDIARIES
Entity Type:Organization
Organization Name:QUEEN'S DEVELOPMENT CORPORATION & SUBSIDIARIES
Other - Org Name:QUEEN'S HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-535-8709
Mailing Address - Street 1:1099 ALAKEA ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4512
Mailing Address - Country:US
Mailing Address - Phone:808-535-8737
Mailing Address - Fax:808-535-8710
Practice Address - Street 1:599 FARRINGTON HWY STE 201
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2028
Practice Address - Country:US
Practice Address - Phone:808-674-9500
Practice Address - Fax:808-674-9436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH103153Medicare PIN