Provider Demographics
NPI:1821628280
Name:RESIDENTIAL YOUTH SERVICES & EMPOWERMENT
Entity Type:Organization
Organization Name:RESIDENTIAL YOUTH SERVICES & EMPOWERMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-260-0348
Mailing Address - Street 1:42-470 KALANIANAOLE HWY
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4373
Mailing Address - Country:US
Mailing Address - Phone:808-498-5180
Mailing Address - Fax:
Practice Address - Street 1:42-470 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4373
Practice Address - Country:US
Practice Address - Phone:808-498-5180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health