Provider Demographics
NPI:1952670358
Name:PARENT CHILD DEVELOPMENT CENTER WAHIAWA
Entity type:Organization
Organization Name:PARENT CHILD DEVELOPMENT CENTER WAHIAWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGASHI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-621-2322
Mailing Address - Street 1:1403 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2583
Mailing Address - Country:US
Mailing Address - Phone:808-621-2322
Mailing Address - Fax:808-621-5033
Practice Address - Street 1:1403 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2583
Practice Address - Country:US
Practice Address - Phone:808-621-2322
Practice Address - Fax:808-621-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI64644003Medicaid