Provider Demographics
NPI:1710258405
Name:LANAKILA EARLY CHILDHOOD SERVICES PROGRAM
Entity Type:Organization
Organization Name:LANAKILA EARLY CHILDHOOD SERVICES PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH SUPERVISOR I
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ING UEMURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-832-5688
Mailing Address - Street 1:1700 LANAKILA AVE RM 210
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2115
Mailing Address - Country:US
Mailing Address - Phone:808-832-5688
Mailing Address - Fax:808-832-5698
Practice Address - Street 1:1700 LANAKILA AVE RM 210
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2115
Practice Address - Country:US
Practice Address - Phone:808-832-5688
Practice Address - Fax:808-832-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI64626801Medicaid