Provider Demographics
NPI:1457620650
Name:KONA ASSOCIATION FOR RETARDED CITIZENS
Entity Type:Organization
Organization Name:KONA ASSOCIATION FOR RETARDED CITIZENS
Other - Org Name:THE ARC OF KONA/KONA KRAFTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-323-2626
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-0127
Mailing Address - Country:US
Mailing Address - Phone:808-323-2626
Mailing Address - Fax:808-323-9444
Practice Address - Street 1:81-1065 KONAWAENA SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-8121
Practice Address - Country:US
Practice Address - Phone:808-323-2626
Practice Address - Fax:808-323-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI517055-01Medicaid