Provider Demographics
NPI:1790930675
Name:HAWAII HEALTHCARE PROFESSIONALS, INC.
Entity Type:Organization
Organization Name:HAWAII HEALTHCARE PROFESSIONALS, INC.
Other - Org Name:HAWAII PROFESSIONAL HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUTOZ-DEHARNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-396-2160
Mailing Address - Street 1:377 KEAHOLE ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-3405
Mailing Address - Country:US
Mailing Address - Phone:808-396-2160
Mailing Address - Fax:808-396-2161
Practice Address - Street 1:377 KEAHOLE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3405
Practice Address - Country:US
Practice Address - Phone:808-396-2160
Practice Address - Fax:808-396-2161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAWAII PROFESSIONAL HOMECARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10534287251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52316901Medicaid
HI127024Medicare PIN