Provider Demographics
NPI:1700025368
Name:PACIFIC AUTISM CENTER
Entity Type:Organization
Organization Name:PACIFIC AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-523-8188
Mailing Address - Street 1:670 AUAHI ST STE A6
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5166
Mailing Address - Country:US
Mailing Address - Phone:808-523-8188
Mailing Address - Fax:808-523-1687
Practice Address - Street 1:670 AUAHI ST STE A6
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5166
Practice Address - Country:US
Practice Address - Phone:808-523-8188
Practice Address - Fax:808-523-1687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency