Provider Demographics
NPI:1205108461
Name:HALE NUI COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:HALE NUI COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ULEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-223-8840
Mailing Address - Street 1:PO BOX 1160
Mailing Address - Street 2:
Mailing Address - City:WAIALUA
Mailing Address - State:HI
Mailing Address - Zip Code:96791-1160
Mailing Address - Country:US
Mailing Address - Phone:808-637-2646
Mailing Address - Fax:808-637-4577
Practice Address - Street 1:67-292 GOODALE AVE
Practice Address - Street 2:#A6
Practice Address - City:WAIALUA
Practice Address - State:HI
Practice Address - Zip Code:96791-9664
Practice Address - Country:US
Practice Address - Phone:808-637-2464
Practice Address - Fax:808-637-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI00543092251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00543092Medicaid