Provider Demographics
NPI:1295341915
Name:CARERESOURCE HAWAII
Entity type:Organization
Organization Name:CARERESOURCE HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:THAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKASUGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-599-4999
Mailing Address - Street 1:680 IWILEI RD STE 660
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5392
Mailing Address - Country:US
Mailing Address - Phone:808-599-4999
Mailing Address - Fax:808-531-2832
Practice Address - Street 1:680 IWILEI RD STE 660
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5392
Practice Address - Country:US
Practice Address - Phone:808-599-4999
Practice Address - Fax:808-531-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI533275Medicaid