Provider Demographics
NPI:1780750372
Name:SUSANNAH WESLEY COMMUNITY CENTER
Entity type:Organization
Organization Name:SUSANNAH WESLEY COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:HIGASHI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:808-847-1535
Mailing Address - Street 1:1117 KAILI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3432
Mailing Address - Country:US
Mailing Address - Phone:808-847-1535
Mailing Address - Fax:808-847-0787
Practice Address - Street 1:1117 KAILI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3432
Practice Address - Country:US
Practice Address - Phone:808-847-1535
Practice Address - Fax:808-847-0787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000500207OtherHMSA PROVIDER ID
HI246839Medicaid