Provider Demographics
NPI:1881967438
Name:PACBLU
Entity type:Organization
Organization Name:PACBLU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-955-2900
Mailing Address - Street 1:1357 KAPIOLANI BLVD
Mailing Address - Street 2:STE 1015
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4549
Mailing Address - Country:US
Mailing Address - Phone:808-955-2900
Mailing Address - Fax:808-955-2925
Practice Address - Street 1:1357 KAPIOLANI BLVD
Practice Address - Street 2:STE 1015
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4549
Practice Address - Country:US
Practice Address - Phone:808-955-2900
Practice Address - Fax:808-955-2925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management