Provider Demographics
NPI:1184364184
Name:HERITAGE HEALTH SERVICES OF HAWAII LLC
Entity type:Organization
Organization Name:HERITAGE HEALTH SERVICES OF HAWAII LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBREPENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-202-7888
Mailing Address - Street 1:1003 BISHOP ST STE 2700
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-6475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1003 BISHOP ST STE 2700
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6475
Practice Address - Country:US
Practice Address - Phone:808-202-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care