Provider Demographics
NPI:1669738027
Name:WINDWARD EARLY CHILDHOOD SERVICES PROGRAM
Entity type:Organization
Organization Name:WINDWARD EARLY CHILDHOOD SERVICES PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH SUPERVISOR I
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUWAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-233-5495
Mailing Address - Street 1:45-691 KEAAHALA RD RM 30
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3569
Mailing Address - Country:US
Mailing Address - Phone:808-233-5495
Mailing Address - Fax:808-233-5494
Practice Address - Street 1:45-691 KEAAHALA RD RM 30
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3569
Practice Address - Country:US
Practice Address - Phone:808-233-5495
Practice Address - Fax:808-233-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI64626803Medicaid