Provider Demographics
NPI:1770512048
Name:ELAM SPORTS, INC.
Entity Type:Organization
Organization Name:ELAM SPORTS, INC.
Other - Org Name:ELAM SPORTS OAHU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPANY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-674-9595
Mailing Address - Street 1:1001 KAMOKILA BLVD
Mailing Address - Street 2:SUITE 111 JCB
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2014
Mailing Address - Country:US
Mailing Address - Phone:808-674-9595
Mailing Address - Fax:808-674-9696
Practice Address - Street 1:425 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 2B
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3238
Practice Address - Country:US
Practice Address - Phone:808-674-9595
Practice Address - Fax:808-674-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50320201Medicaid
HIA218931OtherHMSA
HI53533Medicare ID - Type Unspecified